transitioning department patients from · collected as part of the research study and transferred...

2018 Annual Report 1

Translational research: From bench to bedside

DEPARTMENT OF PAEDIATRICS

ANNUAL REPORT

2018

Innovative techniques for answering clinical questions Transitioning

patients from paediatric to adult health care

Improving safety and quality of care

2 Department of Paediatrics

I C O M P L E T E D A 1 0 Y E A R T E R M A S D E P A R T M E N T H E A D O N N O V E M B E R 3 0 , 2 0 1 8 and so this introduction to our 2018 Annual Report is also an opportunity to say thank you and farewell. It has been a great honour and privilege to lead the Department of Paediatrics and it has been most satisfying to support and witness the great work done by all of you, towards the common goal of providing first class care to children and their families.

Over the last decade, the Department of Paediatrics has come a long way. We have grown more than 80% to over 400 full and affiliate members and, by any objective measure, we are now better at all that we do. Being larger has given us critical mass and this has led to a synergistic effect where our whole is much greater than the sum of our parts.

Working with our colleagues across the clinical and academic spectrum, we are better generally, and in specific areas such as life-saving and critical care, and across the span of our subspecialty services. We are better at providing care in the community and reaching out to vulnerable populations locally and across the globe. Our training programs are strong and continuously successful. In research and scholarly work, we are on a steep ascent of improved productivity, year over year, not only in grants received and papers published, but in the impact of our research.

MESSAGE FROM DEPARTMENT HEAD

Optimizing antimicrobial use through evidence- informed initiatives Page 44

01 Message from Department Head

06 From the Bench: Translational research at the Alberta Children’s Hospital and beyond

07 Establishing the BioCORE at the Alberta Children’s Hospital

09 Biobanking for paediatric cancer research

10 RapidOmics: Bringing translational research to the bedside

12 Other research developments in the Department of Paediatrics

14 To the Bedside: Elevating the standard of patient care

15 Coordinated expertise for optimal management of congenital heart disease

18 Implementing innovative techniques to answer clinical questions at the bedside

21 Utilization of point-of-care ultrasound throughout the Alberta Children’s Hospital

22 Education at the bedside and beyond

23 Undergraduate Medical Education initiative experiences significant expansion

24 Q&A with paediatric cardiologist Dr. Joyce Harder

26 The evolution of cardiology: Dr. Joyce Harder’s journey in medicine

28 Cutting-edge technology for critically ill patients

30 The transformative power of organ donation for families and health-care providers

32 Bridging the Gap: From hospital to community

33 Evaluating the impacts of a patient navigator service on transition to adult care

35 Discipline-specific transition programs

36 A week in the life of a community paediatrician

41 Calgary Adolescent Treatment Services (C.A.T.S.) Clinic moves to new campus of Woods Homes

42 And Beyond: Improving safety and quality of care at the Alberta Children’s Hospital

43 Safest Together: Prioritizing patient safety through collaboration

44 Optimizing antimicrobial use through evidence-informed initiatives

47 Improving quality and safety of patient care with CATCH Rounds

49 Our Community Outreach


54 Clinical Activity

59 Research Metrics

60 Our Recognition

This report includes data and events from the calendar year 2018, academic year July 2017 – June 2018, and fiscal year April 2017 – March 2018. Respectfully submitted by: Dr. Mark Anselmo, Associate Professor and Head, Department of Paediatrics, Cumming School of Medicine, University of Calgary and Calgary Zone, Alberta Health Services.

The transformative power of organ donationPage 30

A week in the life of a community paediatricianPage 36

Q&A with paediatric cardiologist Dr. Joyce Harder4

2 Department of Paediatrics 2018 Annual Report 3

Of course, we must not be satisfied or complacent going forward. There are still important challenges to face and opportu-nities for further growth and development. While we have come a long way in the last decade, and in the decades before that, we still have some ways to go to be truly excellent and self-sustaining in all that we do. But we are well on our way!

Thank you very much to the many colleagues and friends who have helpfully encouraged, supported and challenged me along the way, including medical, operational and administrative leaders and members in the Department of Paediatrics, Cumming School of Medicine, Alberta Health Services, Alberta Children’s Hospital Research Institute, Alberta Children’s Hospital Foundation, and the Paediatric Chairs of Canada.

Congratulations and good luck to our new Department Head, Dr. Mark Anselmo. Dr. Anselmo is a paediatric respirologist who was recruited from Montreal to Calgary in 2010 to be Section Chief of Paediatric Respirology. In 2014, he became the Facility Medical Director for the Alberta Children’s Hospital. Thank you Mark for your willingness to step into the role and I wish you every success leading our wonderful department!

DR. JIM KELLNER Professor and former Head, Department of Paediatrics Cumming School of Medicine, University of Calgary Calgary Zone, Alberta Health Services

Living our vision, mission, and values

VisionExcellence in:

– Clinical Service – Advocacy and Leadership – Research – Education

MissionTo promote, maintain, and restore health in children by:

– Delivering high quality, evidence–based clinical care – Training care givers at all levels – Innovation and dissemination of new knowledge

Values – Compassion – Respect – Integrity – Collaboration – Leadership – Innovation

62%62% female membership within the department

1919 academic promotions in 2018, the most ever in a single year

277% 277% increase in clinical research revenue since 2012

28 females in academic or clinical leadership positions

RECOGNITION

Dr. Jim Kellner was the recipient of this year’s Physician of the Year Award from the Alberta Children's Hospital Medical Staff Association (ACH MSA). 28

RIGHT: Dr. Mark Anselmo (left) has taken over as Head of the Department of Paediatrics as of December 1, 2018. Our former Head, Dr. Jim Kellner (right), led the Department of Paediatrics for ten years.


share our stories and celebrate our achievements

RECOGNITION

Numerous members within the Department of Paediatrics have been recognized over the past year for their valuable contributions, both locally and across the country.

OUTREACH

Our researchers and clinicians continually reach outside our hospi-tal to help support and promote the health of children in our local commu-nities and beyond.

COLLABORATION

Our members are increasingly sought out to lead and/or participate in collaborative initiatives, promot-ing dissemination of knowledge and expertise among our local, national, and global partners.

INNOVATION

The Department of Paediatrics aims to promote health in children through its focus on innovation, utilizing state-of-the-art technologies and advancing best practices to provide care with far reaching impacts.

VISION

Our vision encompasses four CARE pillars: – Excellence in Clinical Service – Advocacy and Leadership – Research – Education.

400+365

400,000+DAYS OPEN

DEPARTMENT MEMBERS

OUTPATIENT AND EMERGENCY VISITS


The BioCORE facility was established under the umbrella of the acclaimed paediat-ric NeuroCritical Care (NCC) program, a collaborative ini-tiative to bring translational research to the bedside for patients with brain injuries in the paediatric and neonatal inten-sive care units (PICU and NICU).

“The Alberta Children’s Hospital had all of the pieces in place to build this program, we just needed to put it all together,” says Dr. Michael Esser, paediat-ric neurologist and Director of both the NCC program and the BioCORE. As such, the BioCORE was built from within, capital-izing on the complementary expertise of various groups, including but not limited to paediatric neurology, paediat-ric intensive care, neonatology, neurosurgery, and rehabili-tation medicine. Located on the lower level of the hospital, the BioCORE is a partnership with the Biochemical Genetics Lab led by Dr. David Sinasac, who is also the Director of Operations for the BioCORE. As a core facility for paediatric research, the BioCORE aims to provide guidance and support for researchers within the Department of Paediatrics and the Alberta Children's Hospital

Research Institute (ACHRI) who are undertaking transla-tional research projects. Both the BioCORE and the overar-ching NCC program have been funded by generous community donations through the Alberta Children’s Hospital Foundation.

The BioCORE facility houses state-of-the-art technology, including a biobank repository which stores and catalogues biological samples from patients within the NCC program, as well as other inpatient and out-patient research initiatives at the Alberta Children’s Hospital. Samples – which can be blood, urine, or cerebrospinal fluid – are collected as part of the research study and transferred to the BioCORE biobank for preser-vation in ultra-low temperature (-80 degrees Celsius) freezers, allowing researchers to safely store, organize, and access these

samples for later analysis. This type of research has the poten-tial to provide novel insights into the underlying biological profile of a particular disease, ultimately leading to a more individualized and patient-centred approach to health care. “We are now in the realm of personalized medicine, where we try to tailor treat-ment to the individual while still using the best evidence possi-ble,” says Esser. “We are starting to better understand the indi-vidual patient to a greater degree than was ever possible before.” In light of this notion, the BioCORE offers bioanaly-sis for patient samples, allowing researchers to evaluate distinct markers of disease and treat-ment response (i.e. metabolites, lipids and proteins). Cutting-edge technology, including Multiplex Immunoassay and high resolution analytical chemistry techniques (Q-TOF LC/MS), can uncover relevant biomarkers for a multitude of conditions, such as those involved in brain injury, inflammation, and cancer. These analyses, which can be targeted or untargeted, allow researchers to rapidly iden-tify biomolecular ‘signatures’ that are unique to an individual patient. “Instead of just looking at one point in time, we are

FROM THE BENCH

Translational research at the Alberta Children’s Hospital and beyond

The Department of Paediatrics has built a strong foundation in research, supporting our teams in finding new and innovative ways of bridg-ing the gap between basic science and patient care. Using a ‘bench to bedside’ approach, research out-comes with transformative promise can be integrated into clinical care, a concept known as translational medicine.

CONTRIBUTOR

Dr. Michael Esser

Establishing the BioCORE at the Alberta Children’s HospitalIssues arising in the clinical setting often lead to complex decisions that could be supported by integrated research. At the Alberta Children’s Hospital, a team of researchers has brought the ability to conduct this research to the hospital setting.

“The outcomes are vastly improved when you have dedicated programs to care for these children.” DR. MICHAEL ESSER,

DIRECTOR,

NEUROCRITICAL CARE (NCC)

PROGRAM AND BIOCORE

RECOGNITION

Paediatric neu-rologist Dr. Jong Rho was awarded the John Freeman Award at the 6th Global Symposium on Ketogenic Therapies for Neurological

Disorders, a lifetime recogni-tion of exemplary dedication to advancing clinical use and scientific understanding of metabolic therapies for neu-rological disorders.


looking at the trend of what is happening and monitoring the patient’s response to targeted therapies over time,” explains Esser. “Using this approach, we can get to know if the child is responding as they should be or if a personalized medicine approach is needed, and this guides us in making the best possible treatment decisions.”

“The ultimate goal would be integration of this platform into clinical care, with the ability for clinicians to send samples right to the BioCORE for rapid processing,” explains Esser, an innovation that he says could be used by any subspecialty within the hospital to provide real-time diagnoses and thera-peutic monitoring for patients. For now, the BioCORE contin-ues to be an invaluable research tool with the potential to aid clinicians in providing focused care for the children who need it most. “The outcomes are vastly improved when you have dedicated programs to care for these children.”

Dr. Michael Esser was the recipient of a 2018 CARE Award (Clinician). See page 60 for details.

RECOGNITION

The Alberta Children’s Hospital Bone Marrow Transplant Program, led by the Sections of Paediatric Oncology/Bone Marrow Transplant and Paediatric Hematology, was the recipient

of an Alberta Health Services President’s Excellence Award for Outstanding Achievement in Innovation and Research Excellence.

The Clark H. Smith Tumour Biobank at the Cumming School of Medicine is a biorepository, storing high quality tissue and other biological samples for use in basic, translational and clini-cal cancer research. The “Bank” specializes in neurologic and paediatric diseases and has filled a critical void in helping research-ers understand the unique underlying biology of a wide variety of childhood cancers.

“There was a real need for biobanking in paediatrics,” explains Dr. Jennifer Chan, Deputy Director of the Arnie Charbonneau Cancer Institute at the Cumming School of Medicine and Co-Director of the Bank with neurosurgeon Dr. Mark Hamilton. Establishment of the paediatric biobanking program required the support of multiple groups and partners at the Alberta Children’s Hospital, including paediatric oncology, surgery, pathology, and nursing. Utilizing the same equipment and exper-tise required for adult tissue banking, the paediatric biobank-ing program has continued to grow since its inception nearly a decade ago. Tissue samples are collected at the time of surgery, following examination by a pathologist to verify the diagno-sis and quality of the specimen.

Following collection, biological samples are processed to pre-serve the cells using a highly specialized method called cryo-protection. “The science has really evolved in biobanking and the initial processing of the cells,” says Chan. “We seek to minimize wastage of the specimen and we have harnessed the poten-tial for the cells to be brought back to life.” As she explains, there’s a big difference between frozen cells that are not cryopro-tected (i.e. a frozen chicken that can’t be brought back to life) versus cryoprotected cells that can be used to establish living cell lines and grow tumours in a petri dish. These live cancer cells can even be transplanted into mice, a research technique known as a patient-derived xeno-graft. “There was a need in the paediatric cancer space for more experimental models that reflect the disease,” says Chan, explain-ing that the broad spectrum of disease in paediatric cancer has been difficult to replicate in the

past without human specimens. In particular, the Bank has spe-cialized expertise in culturing cells from brain tumours, suc-cessfully establishing numerous cell lines from both common and rare brain tumour types. The latest experimental model for brain tumours has been highly successful, with cell lines established from over half of the tumour samples received.

The Bank supports researchers in studying the unique molecular signatures and underlying driver mutations in paediatric cancers, promoting the advancement of precision medicine protocols and enabling investigations such as drug screens, functional studies, and preclinical testing. “The Bank helps a lot of our local investigators, removing barri-ers for research and allowing studies to get up and running faster, while providing access to high quality materials,” explains Chan. The Bank collaborates frequently with researchers from the Department of Paediatrics, including Dr. Greg Guilcher, a hematopoietic stem cell trans-plantation (HSCT) physician and researcher at the Alberta Children’s Hospital. Guilcher and his team are working with the Bank on a project to investigate specific biomarkers following

HSCT for patients with sickle cell anemia, funded by a Department of Paediatrics Innovation Award.

“The Bank can be used for specific disease analysis or con-trols for comparison,” explains Guilcher, sharing that his team develops project ideas and pro-cures samples from the Bank for secondary analysis. “We could not perform this research without the biobank.”

With the ability to send frozen vials across the globe, samples from the Bank can also be shared with researchers at collaborating institutions both nationally and internationally.

“Certain tissues have travelled all over the world and that work has been highlighted in high impact journals,” explains Chan. Most importantly, the Bank has established far-reaching impacts, adding to the shared goal of advancement in paediat-ric cancer research for our past, present, and future patients.

“We educate researchers about the translational clinical rele-vance of this work. There is a huge potential for discovery and long-term empowerment of research.”

Dr. Greg Guilcher was the recipient of a 2018 CARE Award (Researcher). See page 61 for details.

RECOGNITION

Dr. Adam Kirton, a paediatric neurologist and member of the NeuroCritical Care (NCC) team, was inducted by the Royal Society of Canada (RSC) as a Fellow of the College of New Scholars, Artists and Scientists. The fellowship of the RSC comprises over 2000 scholars, artists, and scien-tists, peer-elected as the best in their field.

RIGHT: The NeuroCritical Care (NCC) program at the Alberta Children’s Hospital was the first of its kind in Canada, providing highly personalized care for children whose brains are at risk from critical con-ditions, including traumatic brain injuries, stroke, infection, brain tumours, and hypoxia. When Alivya (right) was born she was at risk of brain injury resulting from lack of oxygen or blood flow to the brain,

a condition called hypoxic ischemic encephalopathy (HIE). Expert care provided by the NCC team at the Alberta Children’s Hospital ultimately saved Alivya’s life and she is now thriving at the age of two (below), with ongoing support from the NCC program as part of her continuum of care.

CONTRIBUTORS

Dr. Jennifer Chan, Dr. Greg Guilcher

Biobanking for paediatric cancer researchBiobanks are critical to the advancement of translational cancer research, enabling clinicians to uncover the mysterious mechanisms involved in the development and progression of paediatric cancers, including the patient’s response to treatment and long-term outcomes.

“We have harnessed the potential for the cells to be brought back to life.”DR. JENNIFER CHAN,

CO-DIRECTOR,

CLARK H. SMITH TUMOUR BIOBANK


A new collaboration between the Sections of Medical Genetics and Paediatric Critical Care at the Alberta Children’s Hospital aims to provide access to real-time genetic testing, particularly whole exome sequencing, for patients admitted to the paedi-atric intensive care unit (PICU).

“The goal for this project is to find a more rapid and effective way to arrive at a diagnosis for patients with underlying genetic diseases,” explains Dr. Francois Bernier, Section Chief of Medical Genetics, adding that this process exemplifies the ‘bench to bedside’ approach.

The RapidOmics project is a multidisciplinary collabora-tion between paediatric critical care, medical genetics, Genetic Laboratory Services, and the Molecular Diagnostics Laboratory at the Alberta Children’s Hospital, which includes postdoctoral associate Dr. Amanda Tyndall, lab technician Dr. Melanie Keller, and molecular geneticists Dr. Jillian Parboosingh and Dr. Ryan Lamont. The RapidOmics project is funded by generous commu-nity support through the Alberta Children’s Hospital Foundation.

Typically, the medical genetics team will be involved in the very early stages of care management for critically ill patients.

Standard of care testing for all patients in the PICU now includes DNA sequencing as part of the RapidOmics study.

“If the patient is eligible, the PICU will contact our research team and consent is secured from the patient’s family for par-ticipation in the study,” explains Bernier. DNA is extracted from the patient’s blood sample and whole exome sequencing, which analyzes roughly 20,000 genes, is performed in house at the Alberta Children’s Hospital. This process produces massive amounts of data, which is then uploaded to an external server. A multidisciplinary meeting is arranged for the research team and clinicians to discuss the results, followed by final interpretation and reporting. In November 2018, the first patient case was fully sequenced, taking only 10 days from initial collection of the sample to completion of the report.

“Rapid diagnosis not only reduces costs, it also provides better guidance in terms of initial treatment for these acutely ill children,” says Bernier, explaining that some of these patients may require changes in care manage-ment or escalation/de-escalation of care depending on the results obtained from DNA sequencing.

“There are lots of investigations involved in these cases, so we are looking at whether we can cut down on the complexity of the workup.”

The second part of this project will evaluate its impact, promoting further understand-ing of how rapid diagnosis in the early stages of care management may change treatment pathways and provide more timely infor-mation for families. “This piece fits more into clinical translation, looking at how we can take what we already know – that whole exome sequencing is likely to be cost effective and provide valuable, rapid answers – and actually prove that in our setting,” explains Bernier. “This would be the starting point of understand-ing how we can roll out genetic testing more rapidly and effec-tively to the rest of the hospital.”

There are limitations to this approach, however, as the exome comprises only ~3% of the whole human genome.

Patient cases that remain unsolved after the initial round of sequencing described previously would be eligible for a broader project entitled “Care4Rare Canada: Harnessing Multi-omics to Deliver Innovative Diagnostic Care for Rare Genetic Diseases in Canada (C4R-SOLVE),” which received $10 million in funding from Genome Canada earlier this year across its participating sites. Led by Bernier, this par-ticular research project will dive even deeper, integrating cut-ting-edge technology for cases in which an underlying genetic disorder is suspected but the diagnosis remains unsolved after the first round of clinical testing.

“The aim of this project is to use whole genome sequencing to try to solve the unsolved cases, sequencing all three billion letters in the genome,” says Bernier, which can now be done by a single instrument for about $1,000. The goal of this project is to foster the discovery of novel genes while further support-ing the broader scope of whole genome research. “We still have to understand what is contained in the genome that we aren’t able to see under the lamp post of exome sequencing. We need to know what remains in the dark, and how we can use this analogy to spread the light.”

Whole Genome Sequencing in Humans

The cost and time required for whole genome sequencing has changed dramat-ically since the Human Genome Project was completed, enabling the discovery of more than 1,800 disease genes in humans and the development of over 2,000 genetic tests for a wide variety of health conditions.

2003 2018

2413

$2.7

$1

YEARS

BILLION

THOUSAND

HOURS

RIGHT: The RapidOmics team reported its first case from Banff while attending an Alberta Children’s Hospital Research Institute (ACHRI) retreat there in November 2018, just ten days from initial retrieval of the patient sample. Ultimately, the team aims to expand access to rapid genetic testing which will help in guiding treatment decisions and care management for patients through-out the Alberta Children’s Hospital.

CONTRIBUTOR

Dr. Francois Bernier

RapidOmics: Bringing translational research to the bedsideFor complex cases, finding an underlying diagnosis can be like finding a needle in a haystack – there are no immediate answers. For critically ill patients, this process is especially time-sensitive, requiring reliable methods to detect potential genetic causation and direct optimal care management.

“Rapid diagnosis not only reduces costs, it also provides better guidance in terms of initial treatment.”DR. FRANCOIS BERNIER,

SECTION CHIEF,

MEDICAL GENETICS

In 1990, the Human Genome Project set out to sequence the complete human genome. The project culminated in 2003, taking 13 years total to complete. Now, rapid sequenc-ing of the human genome can be achieved in less than 24 hours.

The Human Genome Project is estimated to have cost around $2.7 billion. Whole genome sequenc-ing can now be completed with a single instrument for approximately $1,000 with 99.99% accuracy.

Whole Exome Sequencing

Genetic information contains three billion letters and about 20,000 genes, which are made up of noncoding (intron) and coding (exon) regions. In whole exome sequenc-ing, the noncoding regions are removed and only the protein-coding regions, the exons, are sequenced.


Recognition In Research

Highlights within the Department of Paediatrics.

The Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE), led by principal investigator and member of the Sections of Paediatric Emergency Medicine and Paediatric Gastroenterology Dr. Stephen Freedman, was the recipient of an Alberta Health Services President’s Excellence Award for Outstanding Achievement in Innovation and Research Excellence.

Freedman was also awarded the Top Paediatric Abstract Award at the Canadian Association of Emergency Physicians 40th Annual Conference for his project entitled: “Probiotic Regimen for Outpatient Gastroenteritis – Utility of Treatment (PROGUT) Study: A Multicenter Randomized Controlled Trial.”

This past year, the Alberta Pregnancy Outcomes and Nutrition (APrON) Study reached a signif-icant landmark in publishing 50 peer-reviewed publications. Led by researcher Dr. Nicole Letourneau, Alberta Children’s Hospital Foundation Chair in Parental-Infant Mental Health, the study aims to improve the overall health and long-term potential of mothers and newborn babies in Alberta.

Dr. Laura Flores-Sarnat was the recipient of the 2018 Outstanding Editorial Board Member Award for the publica-tion Pediatric Neurology, in recognition of out-standing service and numerous contributions to the journal.

Dr. David Johnson was the recipient of the Career Research Award from the Canadian Paediatric Society (CPS), which rec-ognizes the career of an outstanding and accomplished researcher working on an aspect of paediatric research in Canada.

Introducing the Child & Family Health Research Unit

In the fall of 2018, the Department of Paediatrics announced its newest section: the Child & Family Health Research Unit. The creation of this academic section has unified numerous PhD researchers within our department, including Dr. Brent Hagel, Dr. Deborah Dewey, Dr. Gerry Giesbrecht, Dr. Alberto Nettel-Aguirre, Dr. Maria Santana, and Dr. Suzanne Tough. “It really began with us exploring the idea of a section of PhD researchers, while looking to build greater academic affiliation, sense of identity, and collegiality,” explains Hagel, Director of the new unit and acting Deputy Head of Research for the Department of Paediatrics. The Child & Family Health Research Unit will provide the framework for increased productivity and help promote further opportunities to col-laborate with the department’s numerous clinician-scientists to affect positive change. “We feel that together we can bring content expertise and research leadership, with the idea that the whole is greater than the sum of its parts.”

Visit our website for a list of 2018 publications from the Department of Paediatrics: www.ucalgary.ca/paed/about

Improving outcomes for acutely ill and injured children

In the past year, over 77,000 ill and injured children were seen in the emergency department at the Alberta Children’s Hospital. The Paediatric Emergency Research Team (PERT) is one of the largest paediatric emer-gency medicine research teams in the country. From July 2017

– June 2018, PERT and the Section of Paediatric Emergency Medicine continued to advance their mission of improving out-comes for acutely ill and injured children by creating and sharing new knowledge, enrolling more than 900 patients, generating 65 publications, and receiving over $10 million in grant funding (total principal investigator/co-principal investigator and co-investigator/collaborator).

Visit our website for the Paediatric Emergency Research Team (PERT) 2018 Annual Report: www.ucalgary.ca/paed/section/emergency-medicine

A review of the Innovation Award program

The Department of Paediatrics Innovation Award program is an internal funding com-petition intended to provide operating funds to support innovative projects related to

the provision of clinical care, education, or research that will ultimately result in better health care or improved health outcomes for children and fam-ilies. To date, the program has promoted collaboration both within the department and with other departments across the University of Calgary and Alberta Health Services, as well as other institutions and organizations. A review of the Innovation Award program was conducted this past year, fol-lowing six funding competitions. Since 2012, 146 applications from 24 areas/sections have been submitted. A total of 42 awards have been granted, with $881,413.54 distributed. Of the 42 projects funded, 10 have been completed thus far. Completed and ongoing proj-ects have resulted in over 22 peer-reviewed publications, poster and oral presentations, as well as multiple external grant applications related to the proj-ects (e.g. continuation or next steps). The projects funded have included an array of innovative ideas, methods, approaches and tools, including websites, mobile applications (“apps”), new diagnostic methods, curriculum changes, clinical pathways and quality improvement initiatives.

Clinician-Scientist updates within the Department of Paediatrics

Dr. Susan Samuel was selected as the new Director of the Canadian Child Health Clinician Scientist Program (CCHCSP). Founded in 2002, the CCHCSP is a transdisciplinary training program for the next gener-ation of clinician-scientists in child and youth health research in Canada. Clinician-scientists are champions for change and innovation, providing leadership in diverse settings that include senior academia, health services and policy-making. As part of this role, Samuel will advocate for trainees and the CCHCSP program both nationally and internationally to help advance child health research.

Clinician-scientist Dr. Kara Murias was the first graduate from the University of Calgary’s Clinician Investigator Program (CIP) to join the Department of Paediatrics. Murias has joined the Section of Developmental Paediatrics as a physician and researcher within the Owerko Centre, after completing her paediatric neurology residency and a PhD in Neuroscience at the University of Calgary.

Living Our Values Through Vision

Strategic plan-ning for the Child & Family Health Research Unit was guided by the creation of the following:

VISION

A better world through excellence in research.

MISSION

To generate evidence to promote the best life possible for children and families.

VALUES

– Innovation – Leadership – Collaboration – Integrity – Mentorship

Living our Values Through Collaboration

Our members continue to demonstrate research excel-lence. For example, PhD research-ers Dr. Deborah Dewey, Director of the former Behavioural Research Unit (BRU) for 12 years, and Dr. Gerry Giesbrecht, have

published 20 papers in the past year. Originally established over 40 years ago, the BRU has recently been amalgam-ated into the new Child & Family Health Research Unit, a collabo-rative union of six PhD research-ers within the Department of Paediatrics.

LEFT: Research enables our teams to integrate evi-dence-informed improvements into patient care, expand our breadth of knowledge, and share novel ideas and dis-coveries with our collaborators.

“We feel that together we can bring content expertise and research leadership, with the idea that the whole is greater than the sum of its parts.” DR. BRENT HAGEL,

DIRECTOR,

CHILD & FAMILY

HEALTH RESEARCH UNIT

Other research developments in the Department of Paediatrics

https://www.ucalgary.ca/paed/about




https://www.ucalgary.ca/paed/section/emergency-medicine






Sometimes, however, develop-ment of the heart doesn’t occur exactly as expected which can result in problems with its structure and function, a group of conditions known as congenital heart disease. Just down the hill from the Foothills Medical Centre, the Maternal Fetal Medicine clinic at EFW Radiology houses a highly specialized service to support pregnant mothers and babies with congenital heart disease. The Fetal Cardiology program involves collaboration across multiple disciplines, including paediatric cardiology, radiol-ogy, medical genetics, nursing, neonatology and perinatology/obstetrics, both in Calgary and in Edmonton at the Stollery Children’s Hospital.

A routine ultrasound is typically completed at 18 to 20 weeks of pregnancy to examine the development of the fetus, at which time the sonographer completes a cursory overview of the organ systems, includ-ing the heart, to look for any gross structural abnormali-ties. “If the sonographer can’t see the baby’s heart or some-thing appears to be abnormal, they will send the mother for a detailed fetal echocardiogram with our Fetal Cardiology team,”

explains Dr. Kim Myers, Section Chief of Paediatric Cardiology in the Department of Paediatrics, noting that approximately 1,100 fetal echocardiograms are com-pleted annually at the clinic.

The team includes three paedi-atric cardiologists with expertise in fetal cardiology – Dr. Kim Myers, Dr. Lindsay Mills and Dr. Deborah Fruitman, who has led the Fetal Cardiology program in Calgary since 2008. Fetal cardiology clinics are currently scheduled every Wednesday and two Tuesdays per month and will likely become more frequent due to an increasing volume of patients.

“There is definitely increasing demand for our services – the indications for fetal echocar-diograms are broadening, and we are also starting to do first trimester screening,” explains Myers, adding that technological advancements and increas-ing proficiency in identifying

congenital heart disease with ultrasound have contributed to this influx.

Immediately following the fetal echocardiogram, the car-diologist reviews the results together with the radiologist and sonographer. This review is followed by a discussion with a neonatologist and perina-tologist – an obstetrician with maternal fetal medicine train-ing – to review the anatomy and physiology of the fetal heart, discuss how the baby is likely to present at birth, and develop a collective plan for the mother and baby going forward. Following this meeting, each discipline meets with the family to review the findings and rec-ommendations, beginning with cardiology. “Families come in for their ultrasound under the assumption that their baby will be perfectly healthy, so it can be very challenging for them to hear that there is a problem with the baby’s heart,” says Myers, explaining that it’s not uncommon for the cardiologist to spend 1-2 hours with a family.

“We review what a normal fetal heart looks like and its physiol-ogy. We explain what is going on with the baby’s heart and what congenital heart disease is. We also review how we expect the

TO THE BEDSIDE

Elevating the standard of patient care

The implementation of innovative techniques and cutting-edge technology is a fundamental part of the ever-evolving journey to provide the best care possible for our patients and families at the Alberta Children’s Hospital and beyond. Furthermore, our teams strive to educate health-care providers and trainees locally, nationally, and internationally, priori-tizing continuing education as a key component in improving quality and safety of care.

“Together, our team does a very good job in supporting these families.” DR. KIM MYERS,

SECTION CHIEF,

PAEDIATRIC CARDIOLOGY

In normal devel-opment, the primitive heart begins beating by the end of the first four weeks of pregnancy, when the baby is about ¼ inch long (smaller than a grain of rice).

CONTRIBUTORS

Dr. Kim Myers, Dr. Deborah Fruitman

Coordinated expertise for optimal management of congenital heart diseaseIncessantly at work, a healthy adult heart beats over 100,000 times per day, pumping roughly 1.5 gallons of blood every minute through more than 95,000 kilometres of blood vessels. Remarkably, this work starts as early as four weeks after conception when the primitive heart, the first organ to develop in the growing human embryo, starts beating and blood circulation begins.

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baby to present when they are born; for example, the baby may be blue at birth due to poor lung perfusion.” For complex cases, the cardiologist walks the family through highly complicated sur-geries and potential long-term complications. The family then meets with the perinatologist to review the growth of the baby, other anomalies (if present), and the labour and delivery plan. Furthermore, the perinatologist will discuss any potential inter-ventions that may be required during pregnancy and provide answers to questions about discontinuing pregnancy if nec-essary, allowing families to make informed decisions. If the fetus is found to have a complex heart condition, a medical geneticist will also meet with the family to take a very detailed family history and help them gather other essential information. The medical geneticist assists the family in determining whether prenatal genetic testing, such as amniocentesis, is likely to provide additional information or help identify if the congeni-tal heart disease is associated with an underlying syndrome or other genetic condition. Lastly, a registered nurse coordinates all current and past documentation, acting as a liaison with the Fetal

Cardiology program to answer questions and provide ongoing support for families. “All of these meetings take place at the Maternal Fetal Medicine clinic, so it’s really a one-stop-shop for families to get all of this infor-mation in one setting,” explains Myers. “Together, our team does a very good job in supporting these families, restoring the hope that we can treat or repair the heart disease or for highly complex cases, providing assur-ance that we have strategies in place to palliate the child.” The multidisciplinary team contin-ues to work with mothers and families throughout pregnancy, delivery, and post-delivery to support the heart health of the child. “Identifying congenital heart disease early in preg-nancy provides an opportunity for information-gathering for these families, as well as timely planning and decision-making,” explains Myers.

The Fetal Cardiology program includes extensive collaboration and coordination of care with the Stollery Children’s Hospital in Edmonton, the designated centre for cardiac surgery in our province. If a baby is expected to present with severe con-genital heart disease requiring surgical intervention in the first few weeks of life, a multidisci-plinary meeting is arranged at around 32 weeks of pregnancy and the family is relocated to Edmonton prior to delivery. The delivery and congenital cardiac surgery take place in Edmonton and, once the baby is stabilized, the family returns to Calgary for follow up and ongoing paediatric care. “We have become experts in moving families around the province to have these interventions,” says Myers, explaining that their team has built a very close relation-ship with various services in Edmonton, including the Ronald McDonald House to accommo-date relocated families. “It’s an amazing collaboration.”

In developed countries, the vast majority of babies born with congenital heart disease are now identified prenatally. Coordinated efforts such as the Fetal Cardiology program allow health-care providers to

respond to developing fetal heart conditions at the earli-est possible opportunity. “If we know that a baby will be born with congenital heart disease, we can ensure they are delivered in a tertiary care centre with access to necessary supports. We keep them in the hospital to confirm their diagnosis and ensure they are stable, and make a treatment plan going forward,” explains Myers. “There is abun-dant evidence that prenatal diagnosis improves care and outcomes postnatally, and the EFW Radiology group has done a profound job in bringing many different subspecialties together to do this.”

A family’s experience with the Fetal Cardiology program

Sarah delivered her first two chil-dren at home with midwives and had planned on having the same experi-ence with her third child.

This all changed at her 18-week ultra-sound when it was discovered that her baby had multiple congenital heart defects, prompting a referral to the Fetal Cardiology program in Calgary to follow the baby throughout the remainder of the pregnancy. “The team was able to see the defect and educate us about it right away.

We always felt confident in any decisions we had to make or that were being made for our daughter,” explains Sarah of her experience with the program.

“Everyone we’ve had in our corner has been amazing, sup-portive and warm. They provided comfort in what was a very scary situation.” The family relocated to

Edmonton three weeks before the due date to meet with the special-ists who would be involved in providing care for Sarah and the baby. Her daughter, Ophelia (pictured below), was delivered in Edmonton, had congenital cardiac surgery at just five days old at the Stollery Children’s Hospital, and remained

in hospital for about two weeks following delivery. The family travelled to Edmonton again when she was six months old for a second surgery and has since returned to Calgary where baby Ophelia, now nine months old, is followed by paediatric cardiol-ogist Dr. Lindsay Mills at the Alberta Children’s Hospital.

RIGHT: Dr. Deborah Fruitman, Lead of the Fetal Cardiology program, reviews a fetal echocar-diogram with a sonographer and radiologist. This program helps to ensure that congenital heart disease is detected at the earliest possible oppor-tunity so that patients such as Ophelia (pictured below) have the best possible health outcomes.

“There is abundant evidence that prenatal diagnosis improves care and outcomes postnatally.”DR. KIM MYERS,

SECTION CHIEF,

PAEDIATRIC CARDIOLOGY


The Sonographic Clinical Assessment of the Newborn (SCAN) Training Program is a nonprofit educational initiative led by neonatologists Dr. Sumesh Thomas, Dr. Prashanth Murthy, and Dr. Khorshid Mohammad.

“We started with a clinically relevant question and began building the necessary skills to solve this problem,” says Thomas, Director of the SCAN program. “It was obvious that the technology was readily available, but we were not using it to its full potential to help improve diagnosis and increase our success with procedures.” Funded by the Section of Neonatology in the Department of Paediatrics and the Postgraduate Medical Education program at the Cumming School of Medicine, the SCAN program allows health-care practitioners to augment their existing clin-ical skills with ultrasonography, aiding them in answering specific clinical questions at the bedside. The SCAN program is the first of its kind to develop a specific curriculum for the application of ultrasound in new-borns, creating a niche where frontline clinicians – including registered nurses, respiratory therapists, and physicians – can be taught to utilize ultrasound

to perform point-of-care assessments. “We aren’t looking to create specialists or experts with this training,” explains Thomas, adding that the end user isn’t required to know all of the physics behind ultrasound, but rather understand the basics of using the machine and how to optimize the image. “We want to take point-of-care ultrasound where it should be – at the bedside, in the hands of those who deliver care at the bedside.” The SCAN program has initi-ated training with neonatology, where there are over 300 nurses and 20-30 physicians working within the various neonatal intensive care units (NICUs) throughout Calgary.

Opportunities to practice certain skills in neonatology can be limited for trainees as spe-cific clinical presentations are relatively uncommon or can be extremely time-sensitive, and therefore cannot be taught at the bedside. Accordingly, there was a strong need for clinicians to be able to practice these critical skills in a controlled environment. As the Lead for Innovation and Technology for the SCAN program, Dr. Khorshid Mohammad has directed development of computer-based simulators,

high fidelity mannequins, and didactic lectures to teach these skills, in collaboration with com-puter scientist Dr. Sonny Chan and his team of trainees at the University of Calgary. State-of-the-art simulation allows trainees to view anatomical imaging and practice using the ultrasound probe in a realistic setting. Simulations developed to date include, but are not limited to, models for vascu-lar, head, bladder, heart, and lung ultrasound with plans to expand this list in the future. A wide variety of cases have also been replicated for teaching, such as identifying if the heart is empty or full in a newborn with low blood pressure. “The treatment is completely differ-ent based on what is happening,” explains Thomas of this scenario.

CONTRIBUTORS

Dr. Sumesh Thomas, Dr. Khorshid Mohammad, Dr. Prashanth Murthy

Implementing innovative techniques to answer clinical questions at the bedsideThe traditional philosophy of a bench to bedside approach can be reversed when health-care teams begin with an issue identified in patient care, working backwards to find an appropriate solution. A team from the Section of Neonatology within the Department of Paediatrics has taken this approach to develop a specific curriculum for the application of ultrasonography in newborn babies via point- of-care assessments at the bedside.

“We want to take point-of-care ultrasound where it should be – at the bedside, in the hands of those who deliver care at the bedside.”DR. SUMESH THOMAS,

DIRECTOR,

SCAN PROGRAM

Training Workshops Around the Globe

In addition to local and national workshops organized in Calgary and Banff, the SCAN program has conducted international training courses in Ecuador, Kuwait, and India this year, with added workshops planned in Colombia, China, and Alaska over the next 12 months. Using state-of-the-art mannequins and simulation, these workshops provide participants with hands-on ultra-sound training and are attended by a wide variety of health-care professionals.

Celebrating our members’ successes in education

The following members from the Department of Paediatrics were honoured at the Cumming School of Medicine’s Undergraduate Medical Educa-tion Class of 2019 Faculty Apprecia-tion Evening.

GOLD STAR AWARD

FOR COURSE 6

Dr. Leanna McKenzie

GOLD STAR AWARDS

FOR ETHICS

Dr. Gesche Tallen and Dr. Ian Mitchell

HONOUR ROLL

Dr. Glenda Bendiak, Dr. Robin Clegg, Dr. Paul Doughty, Dr. Deborah Fruitman, Dr. Josephine Ho, Dr. Kim Myers, Dr. Kim Smyth, Dr. Theresa Wu

TOP LEFT: Kuwait

BOTTOM LEFT: Ecuador

TOP RIGHT: India

BOTTOM RIGHT: Calgary


“Minutes can mean the difference between life and death, or life-long disability.” This program helps to ensure that trainees are confident in their skills by the time they are required to perform a procedure at the bedside, thus optimizing patient safety. “When I started my train-ing I learned on live patients,” says Thomas, noting that access to simulation training is a relatively new phenome-non. “Technology is constantly improving, and our hope is that our junior faculty and trainees will embrace this technology to enrich their own careers.”

The SCAN program also complements existing infra-structure, such as telehealth, adding yet another level of information that can be shared between health-care sites. For example, ultrasound imaging can be shared with the Southern Alberta Neonatal Transport Service (SANTS) to aid in clinical decision-making and care man-agement for critically ill babies. The SCAN program continues to collaborate with groups at the University of Calgary, including various research teams in point-of-care ultra-sound at the Cumming School of Medicine and KidSONO at

the Alberta Children’s Hospital. Innovative tools such as those developed by the SCAN program enable educators to teach crit-ical skills and expand upon existing knowledge. “We are setting the path for future growth,” explains Dr. Prashanth Murthy, Lead for Education for the program. “Future trainees will start where we are today and take it to the next level.”

In the past year, the SCAN program has conducted local workshops for neonatal fellows, paediatric neurology residents, and general paediatrics resi-dents at the Alberta Children’s Hospital with excellent feed-back. Furthermore, they held a national workshop in Banff earlier this year and will run training courses in Ecuador, Kuwait, India, Colombia, China, and Alaska over the next 12 months. “Our vision for the future is to have partners across Canada and around the globe who can organize similar workshops,” explains Murthy. The SCAN team aims to share this technology at no cost, pro-moting its applicability and transferability across disciplines in paediatric and adult medi-cine. “We are teaching these skills to save children’s lives,”

says Thomas, noting that the team has no interest in com-mercializing this technology.

“This is all for the safety and lives of the children we treat. There is nothing more invalu-able than that.”

RECOGNITION

The Alberta Children's Hospital Paediatric Neuromuscular Program was awarded the Provincial Distinction in Service Delivery Award from Muscular Dystrophy Canada. Led by Dr. Jean Mah, this multidisciplinary team provides

comprehensive evaluation and care management for children with neuromuscular disorders living in southern Alberta, southeastern British Columbia, and southwestern Saskatchewan.

CaRMS Paediatric Subspecialty Matches

All General Pae-diatrics residents who applied for subspecialties this past year were suc-cessfully matched to their program of choice, including:

– Developmental Medicine (Calgary, Montreal)

– Paediatric Critical Care Medicine (Montreal)

– Paediatric Emergency Medicine (Edmonton)

– Gastroenterology (Calgary)

– Paediatric Hematology/Oncology (Calgary)

– Neonatology (Calgary, Edmonton)

CONTRIBUTORS

Dr. Jennifer deBruyn, Dr. Jean Mah

Utilization of point-of-care ultrasound throughout the Alberta Children’s HospitalVarious sections within the Department of Paediatrics have also begun integrating point-of-care ultrasound into patient care, including members within the Sections of Paediatric Gastroenterology, Paediatric Neurology, and Paediatric Emergency Medicine.

Paediatric gastroenterolo-gist Dr. Jennifer deBruyn has pursued training in point-of-care intestinal ultrasound, a novel approach to non-inva-sive monitoring of inflammatory bowel disease activity at the bedside. With funding support from a Department of Paediatrics Innovation Award and a Canadian Association of Gastroenterology Resident Research award, deBruyn is working with paediatric gastro-enterology fellow Dr. Jocelyn Jeong to evaluate the utilization of a newly acquired instrument to provide intestinal ultrasound for patients with inflamma-tory bowel disease within the Gastroenterology Clinic at the Alberta Children’s Hospital.

Muscle ultrasound is another innovative imaging technique that can be performed at the bedside to help diagnose neu-romuscular diseases. This particular diagnostic tool can be used for patients with sus-pected skeletal muscle and nerve pathology, including those with severe illnesses in the paediatric intensive care unit (PICU). Muscle ultrasound is a painless and non-invasive alternative to some diagnos-tic techniques, such as needle

electromyography, and has been increasingly used in clinical practice to screen for neuromus-cular disorders. As part of the paediatric NeuroCritical Care (NCC) initiative at the Alberta Children’s Hospital, the Section of Paediatric Neurology has recently acquired a high-resolu-tion ultrasound machine which will be used in both patient care and research in the near future.

Furthermore, the KidSONO team has integrated point-of-care ultrasound in the emergency department, the paediatric inten-sive care unit (PICU), and other areas throughout the Alberta Children’s Hospital. Utilization of this cutting-edge technol-ogy is now standard practice in many of these areas as a result of ongoing collaborations within the Sections of Paediatric Emergency Medicine, Paediatric Cardiology, and Paediatric Critical Care Medicine, in partner-ship with Paediatric Anesthesia and Paediatric Surgery at the Alberta Children’s Hospital.


– Paediatric Emergencies Alberta Children's Hospital (PEACH) 2018 Conference, March 9 – 10, 2018

– Near-Infrared Spectroscopy (NIRS) Workshop, April 17, 2018

– Dr. Harvey Sarnat Lectureship: “What We Have Learned from Neuropathology,” May 7, 2018

– 5th Annual ACH Paediatric Update Conference, May 10 – 11, 2018

– Joint ACHRI and Department of Paediatrics Symposium 2018: “Bridging the Gap: Integrative Approaches in Child Heath Research,” May 16, 2018

– 2018 ACH Quality Forum, May 31, 2018

– Department of Paediatrics Medical Education Retreat, September 21, 2018

– Helping Babies Breathe Workshop, September 25, 2018

– 3rd Annual Global Child Health Unit Conference, September 26, 2018

– SimPERLS Workshop, September 27, 2018

– Calgary Vasculitis Symposium: “Paradigm Shift in the Diagnosis and Treatment of Vasculitis and Lupus,” October 4, 2018

– 4th Annual Quality & Safety Summit 2018, October 17 – 18, 2018

– 7th Conference on Recent Advances in the Prevention and Treatment of Childhood and Adolescent Obesity, October 25 – 27, 2018

– Nourishing the Neonate Conference 2018: “Optimizing Nutrition for Neonatal Growth & Development Outcomes,” November 6, 2018

– Annual Residents & Fellows Research Day, November 15, 2018

The department also hosts a number of ongoing work-shops targeted towards our internal members, including the Department of Paediatrics Professional Development Series, the Paediatric Lunch & Learn Medical Education Series, and Health Research Platform Strategy Lunch & Learn sessions.

RECOGNITION

Dr. Susanne (Susa) Benseler, Section Chief of Paediatric Rheumatology, was awarded the prestigious James and Nancy Cassidy Award at the 6th Annual James and Nancy Cassidy

Rheumatology Symposium in recognition of sustained excel-lence in care for children with rheumatic diseases and continuous improvement of their outcomes.

RECOGNITION

Dr. Susan Bannister was awarded the Michel Weber Education Award from the Canadian Paediatric Society (CPS), which rec-ognizes a CPS member whose work in medical and/or inter-pro-fessional education has had a signifi-cant and positive impact on learners in child and youth health. Bannister was also a recipient of the Research Paper Award from the Association for

Medical Education in Europe (AMEE) for her presen-tation entitled:

“Not just trust: Factors influencing learners’ technical skill attempts on real patients,” recognizing her demonstrated excellence in medical education research through her presenta-tion at an AMEE Conference.

UPDATE


Last year marked the launch of an innovative ini-tiative for Undergraduate Medical Education called the Cards program. Led by Dr. Susan Bannister, Director of Undergraduate Medical Education (UME) for the Department of Paediatrics, the online educational tool has expanded its reach even further

– it is now used in all 17 of the medical schools across Canada and in more than 20 countries!

Paediatric Hospital Medicine Fellowship

The new University of Calgary Paediatric Hospital Medicine (PHM) fellowship program provides state-of-the art sub-specialty training to prepare physicians in delivering com-petent, evidence-based care to hospitalized children. The fellowship combines individu-alized training and mentorship to support the development of competencies in clinical care, quality improvement, medical education, advocacy and research in the field of Paediatric Hospital Medicine.

Vasculitis Fellowship

The new Vasculitis Fellowship in Paediatric Nephrology and Rheumatology at the University of Calgary consists of combined clinical and research rotations, with ample opportunity to attend vasculitis clinics – includ-ing joint clinics in rheumatology/nephrology and rheumatology/neurology – in both adult and paediatric hospitals. The first Canadian fellow began training in August 2018, with a second international fellow due to start in April 2019. This fellowship has been made possible through the generous donation of the

Dawson Jarock Education fund for Paediatric Nephrology and Paediatric Rheumatology.

Dr. Lorraine Hamiwka, Program Director for Paediatric Nephrology, was the recipient of a 2018 CARE Award (Educator). See page 60 for details.

Bone Marrow Transplant (BMT) Fellowship

The Department of Paediatrics has established fellowship train-ing in Bone Marrow Transplant (BMT), with several one-year trainees since 2010. The program has had two fellows this past year who received more formalized training, with funding from Saudi Arabia, the Cumming School of Medicine’s Department of Oncology, and the Alberta Cancer Foundation. This fellowship offers exposure to BMT in malignant diseases in children, leading programs in hemoglobinopathy and primary immune deficiencies, novel haploidentical BMT techniques, and a comprehensive BMT late effects clinic.

Paediatric Palliative Medicine Subspecialty Residency

The Section of Paediatric Palliative Medicine is part of a nationwide collaboration that is working towards the creation

of a formalized subspecialty residency program with the Royal College of Physicians and Surgeons of Canada.

Preparing for Competence by Design

The Royal College of Physicians and Surgeons of Canada has identified that the traditional model for medical education in Canada may result in gaps in overall competence for medical students and residents. A par-adigm shift in the delivery of postgraduate medical education, Competence by Design (CBD) will transform the current format from a time-based framework to one focused on the trainee’s learning and achievement, increasing responsiveness to fit each resident’s unique educational trajectory. CBD will organize residency train-ing into four developmental stages with distinct, predeter-mined outcomes for each stage. These stage-specific outcomes, called Entrustable Professional Activities and milestones, will be determined by each subspe-cialty as part of their cohort plan for CBD implementation. The Royal College of Physicians and Surgeons of Canada formally launched CBD for Nephrology in July 2018, but launch dates for other subspecialties across

paediatrics have been delayed. The targeted launch date for Gastroenterology has been postponed to July 2019, with Pediatrics and Hematology/Oncology to follow in 2020. The Department of Paediatrics has built a leadership team to help guide our various sections through the transition, which includes Dr. Shirmee Doshi (Assessment Lead), Dr. Gary Galante (Curriculum Lead), and Dr. Theresa Wu (Faculty Advisor Program Lead).

Sharing our knowledge with local, national, and international audiences

Members of the Department of Paediatrics host a wide variety of conferences, symposiums and workshops each year, sharing expertise on the latest updates in paediatric health care, medical education, innovative technolo-gies, and child health research to local, national, and international audiences alike. Notable events for 2018 included the following: – Sonographic Clinical Assessment of the Newborn (SCAN) Workshop, February 13, 2018

– 27th Annual Paediatric Infectious Disease Conference, February 15 – 18, 2018

CONTRIBUTORS

Dr. Suzette Cooke, Dr. Lorraine Hamiwka, Dr. Greg Guilcher, Dr. Marli Robertson, Dr. Marielena DiBartolo, Dr. Amonpreet Sandhu

Education at the bedside and beyondThe Department of Paediatrics provides training for health-care providers at all levels, educating tomor-row's leaders on the latest advancements in the care of infants, children, and adolescents. Through ongoing collaboration and dissemination of knowledge, our teams strive to provide ever more expert and specialized care across all paediatric disciplines.

CONTRIBUTOR

Dr. Susan Bannister

Undergraduate Medical Education initiative experiences significant expansion


With a career spanning almost 40 years, Harder has been instrumental in establish-ing a wide range of innovative techniques for cardiac care in Calgary, such as echocardiogra-phy and cardiac catheterization. Furthermore, she played a crit-ical role in the development of the Western Canadian Children’s Heart Network, the largest geo-graphical network in the world for collaborative care of children with heart disease. Her lead-ership within this network has ensured equal access to high quality cardiac care for all chil-dren requiring interventions, regardless of their proximity to a tertiary care centre.

How did you choose to specialize in cardiology?

While Harder was initially inter-ested in surgery, she ultimately decided to pursue a career in cardiology. “My husband and I trained in orthopedics together. By the end of our training he knew what he wanted to do

– he’s an orthopedic surgeon – and I knew what I did not want to do,” Harder says with a smile. Her chosen specialty, however, is closely interconnected with surgery, as cardiologists and cardiac surgeons rely on each other in many areas includ-ing pre-operative diagnoses,

surgical intervention, and ongoing follow up, representing a true collaborative partnership in the management of care for children with heart conditions. Overall, she is very content in her decision and has thoroughly enjoyed the highly collabora-tive nature of her work. “The best part of a long career is the camaraderie you develop with your colleagues, not just within cardiology, but within all of paediatrics. It’s a wonderful community and a very support-ive place to work.”

What brought you back to Calgary?

Harder and her husband returned to Calgary in 1980 after spending two years training at The Hospital for Sick Children in Toronto. “The job prospects for two specialists in those days weren’t optimal for either of us, but we wanted to be close to family,” she explains. Working as a paediatric cardiologist in those first years did not come without challenges. Before 1990, the Section of Paediatric Cardiology at the Alberta Children’s Hospital did not yet exist and Calgary’s few paediatric cardi-ologists worked independently at community-based clinics. “I worked on my own for the most part from 1980 to 1990.

This experience really made me want to mentor the younger generations of trainees,” she says. “And mentorship is a two way street – they teach me as well.” She began spending a considerable amount of time seeing patients in the paediatric intensive care unit (PICU) and the Alberta Children’s Hospital steadily acquired more and more paediatric cardiologists with subspecialty expertise.

What led to the inception of the paediatric Cardiology Clinic at the Alberta Children’s Hospital?

“My husband and I started with a clinic in the Market Mall Professional Building, sharing office space. I would do rounds at the hospital in the morning, and have clinic at our office in the afternoon.” However, as more and more of cardiol-ogy became hospital-based, it proved increasingly difficult to go back and forth. “I started a clinic at the Alberta Children’s Hospital in 1985 and developed it with our first nurse, Amanda Reid. We would see more complex cases and gradually, I moved out of the Market Mall office.” Harder officially moved her practice to the Alberta Children’s Hospital in 1990 when the hospital added designated

space for cardiology. She also became the Head of the new Division of Paediatric Cardiology at that time, a position she held for 18 years.

What are your plans going forward?

Although Harder still reads echocardiograms at the Alberta Children’s Hospital on a weekly basis, she has largely retired from her clinical work. Harder feels fortunate to have been able to hand her practice over to her daughter, Dr. Erika Vorhies, who also became a paediat-ric cardiologist. In her free time, Harder plans to expand upon her hobbies and prefers to spend time outdoors after working indoors for many years. “My husband and I took up farming in 2000. We run a herd of 40 cattle, grow hay and oats, and have a large garden,” she says. Harder and her husband even built their own house, by hand, on the weekends! Spending ample time on her grandparents’ farm throughout her childhood, she now cherishes time spent on her farm with her own grandchil-dren. Three years ago she began beekeeping, a hobby she says has a steep learning curve. “You have to know the diseases that the bees can get, because they could wipe out the whole hive.”

CONTRIBUTORS

Dr. Joyce Harder, Dr. Kim Myers

Q&A with paediatric cardiologist Dr. Joyce HarderAs one of the first female paediatric cardiologists in Canada, Dr. Joyce Harder has experienced incred-ible transformation, groundbreaking innovation, and radical discovery over the course of her career. She has seen the closely interconnected field of paediatric heart surgery evolve entirely within her lifetime, from what was once a very high-risk practice to present day where post-operative outcomes are uniformly excellent with mortality rates under 1%.

What career path would you have followed if you weren’t a doctor?

“Since I was a child, I have always wanted to be a doctor,” says Harder. “I had never even thought of anything else.” As a young graduate, she persevered as a woman in what was once a predominantly male profes-sion. “My class at medical school had only 12 girls out of 120 total graduates,” says Harder. “It wasn’t like it is now, where the majority of classes are at least 50% females.” Following her childhood dream has led to an amazing career and a far-reach-ing legacy in her field. She has helped mentor new generations of paediatric cardiologists at the Alberta Children’s Hospital and has made a lasting impact on the lives of her patients, who stay in contact with her decades after their last clinic appoint-ment. “One of the really great things you get with a long career like mine is to see my patients and their families grow. I have formed very close rela-tionships with them.”

RIGHT: Dr. Joyce Harder’s daughter, Dr. Erika Vorhies, also became a pae-diatric cardiologist like her mother.

“She’s not neces-sarily following in my footsteps, it’s just in her genes!” Harder laughs.


1990

The paediat-ric cardiology service expanded when Harder was appointed Head of the new Division of Paediatric Cardiology, a role that she held for 18 years. She closed her prac-tice at Market Mall, moving to the Alberta Children’s Hospital full time.

1995

Harder moved the cardiac catheter-ization service from Foothills Medical Centre to the Alberta Children’s Hospital.

2000

The Western Canadian Children’s Heart Network was formed, the largest geographical care network in the world for collabora-tive care of children with heart disease. Harder played a critical role in the development of this network.

Living Our Values Through Innovation

The Alberta Children’s Hospital received a directed donation this year from the Alberta Children’s Hospital Foundation to purchase a new 3T MRI magnet, allowing the Section of Paediatric

Cardiology to expand upon its cardiac MRI program. This year also marked a significant reno-vation to the Cardiology Clinic space, increasing capacity for testing and contributing to improvements in patient care.

2002

Harder was appointed as Section Chief of Paediatric Cardiology, a position she held until 2007.

2003

Harder became Physician Leader for the Department of Paediatrics when it was recognized that the growing department could not be led by the Department Head alone.

2005

An eight-year-old boy became the first child in western Canada to receive an artificial heart at the Stollery Children’s Hospital in Edmonton. The mechanical heart, known as the Berlin Heart, can keep a failing heart beating while a patient awaits a heart transplant.

2017

Harder received the first ever Distinguished Career Award from the Department of Paediatrics, hon-ouring a physician who has provided at least 25 years of exemplary service within the depart-ment (top, second from right).

THE EVOLUTION OF CARDIOLOGY: DR. JOYCE HARDER’S JOURNEY IN MEDICINE

1628

The book De Motu Cordis was pub-lished, describing for the first time how the heart functions and how its two circula-tions, pulmonary and systemic, work together (William Harvey).

1777

The clinical symp-toms of a type of congenital heart defect called tetralogy of Fallot were described for the first time in a young child, referred to as “blue boy” (Eduard Sandifort).

1903

Electrical activity of a human heart was recorded for the first time, producing the first ever electrocardio-gram (ECG) and marking the birth of a new medical specialty (Willem Einthoven).

1929

A surgeon per-formed the first successful cardiac catheterization – on his own heart – in Eberswald, Germany (Werner Forssmann).

1980

Successful appli-cation of the Norwood procedure for hypoplastic left heart syndrome was reported (William Norwood).

1982

Paediatric cardi-ology was moved from Foothills Medical Centre to the Alberta Children’s Hospital, which involved transferring children from the intensive care unit (ICU) to the new site.

1984

The first neona-tal arterial switch operation was described by a team at the Boston Children’s Hospital. Today, this remains the treatment of choice to correct transposition of the great arteries (TGA) with remarkably low mortality (Aldo R. Castaneda).

1985

Harder opened the paediatric Cardiology Clinic at the Alberta Children’s Hospital.

1980

Harder returned to Calgary and estab-lished a paediatric cardiology prac-tice at the Market Mall Professional Building. She also began performing cardiac cathe-terizations at the Foothills Medical Centre.

1953

A sonar machine was used to conduct the first human echo-cardiogram, a non-invasive ultra-sound of the heart (Inge Edler and Hellmuth Hertz).

1953

The first open-heart operation using cardiopul-monary bypass successfully closed an atrial septal defect on an 18-year-old patient in Philadelphia, USA (John Gibbon).

1961

Paediatric car-diology became the first subspe-cialty board in paediatrics.

1967

The world's first human-to-human heart transplant was performed at Groote Schuur Hospital in Cape Town, South Africa (Christiaan Neethling Barnard).

1968

The first heart transplant in Canada was performed at the Montreal Heart Institute (Pierre Grondin).

1974

Dr. Joyce Harder graduated with her medical degree from the University of Alberta, one of only 12 women in her graduating class of 120.

1975

The first success-ful arterial switch operation, a surgi-cal procedure to correct transposi-tion of the great arteries (TGA), was completed in Sao Paulo, Brazil (Adib Dominos Jatene).

1978

Harder completed her residency in Paediatrics at the University of Calgary and moved to Toronto for two years to pursue further training in Paediatric Cardiology at The Hospital for Sick Children.


LEFT: Dr. Joyce Harder with Dr. Mala Arasu, palliative care physician at the Alberta Children’s Hospital.

RIGHT: Dr. Joyce Harder keeps in close contact with many of her patients into adulthood.


This form of dialysis, also known as Continuous Renal Replacement Therapy (CRRT), is an extracorporeal blood puri-fication therapy intended to give the kidneys a chance to rest and recover, ultimately restoring kidney function over extended periods of time. The CRRT machine runs 24 hours a day to mimic the kidney’s normal function in maintain-ing fluid, electrolyte, and acid/base balances in the body, while gently removing excess water and waste products over time. The PrismaFlex system is the standard treatment platform in most Canadian ICUs and allows PICU health-care providers to rapidly initiate 24-hour artifi-cial kidney support day or night, seven days a week for patients whose health is deemed too unstable to tolerate inter-mittent hemodialysis. Close collaboration between the PICU and the Section of Paediatric Nephrology has been a key component to the success of this program. Furthermore, the ability to access this technol-ogy in a seamless fashion and integrate CRRT with all thera-pies required for a critically ill child has helped to remove undo strain on resources needed to provide dialysis therapy to children outside of the PICU.

“Overall it was quite a huge undertaking for our multi-disciplinary team,” explains Dr. Shauna Burkholder, pae-diatric intensivist and Medical Director for the CRRT program in the PICU. The initiative was spearheaded by Burkholder and the Paediatric Intensive Care team, requiring a great deal of additional training and development for all clini-cians involved. Implementation of the CRRT program in the PICU required the training of 28 nurses, including Mary Sutherland as RN Clinical Lead and Joy Handley as Lead Clinical Nurse Educator. The nursing team took it upon themselves to develop an advanced skillset for CRRT, providing expertise and problem solving support for their colleagues in the PICU. This initiative also required the paediatric intensivists to expand upon their existing skillsets. All twelve PICU intensivists at the Alberta Children’s Hospital are now trained to lead CRRT, with Burkholder and Dr. Paul Doughty, paediatric intensivist and Assistant Medical Director for the CRRT program, available for support as needed. The team may also consult their colleagues in paediatric nephrology for additional support and expertise for cases involving CRRT.

The CRRT program requires ongoing teamwork throughout the unit to maintain this unique skillset, with regular group sim-ulation training and continuing education for clinicians. “We are very fortunate to have a highly collaborative, close-knit team in the PICU that works extremely well together,” says Burkholder.

“Our team members are highly engaged and always willing to go above and beyond to help our patients.” Furthermore, an early alert system has been integrated into existing infra-structure to help capture potential patients, enabling the PICU team to start CRRT as soon as possible for the chil-dren who need it. “We need alerts in place so that no patient is missed,” says Burkholder, explaining that continuity of care is extremely important for critically ill patients. “Decisions can be made more quickly based on pre-existing criteria, and we can utilize these metrics to help determine whether a child should or shouldn’t be put on CRRT.” Fourteen patients have received this treatment since implementation of the PICU-led program at the Alberta Children’s Hospital.

RECOGNITION

Dr. Julian Midgley was the recipient of the 2018 Distinguished Service Award

from the Canadian Society of Nephrology (CSN), the first paediat-ric nephrologist to receive this esteemed award.

Continuous Renal Replacement Therapy (CRRT)

CRRT is an extracorporeal blood puri-fication therapy intended to give the kidneys a chance to rest and recover, with an ultimate aim of restoring kidney function over extended periods of time.

access line

return line

replacement fluid

dialysate

effluent

hemofilter

pump

RIGHT: Dr. Shauna Burkholder (right) is one of 12 paediatric intensivists trained to lead continuous renal replacement therapy (CRRT). Furthermore, a total of 28 nurses have developed an advanced skillset for CRRT in the PICU at the Alberta Children’s Hospital, including Lead Clinical Nurse Educator Joy Handley (below).

CONTRIBUTORS

Dr. Shauna Burkholder, Joy Handley, Dr. Paul Doughty, Dr. Jonathan Gilleland

Cutting-edge technology for critically ill patientsGenerous community support through the Alberta Children’s Hospital Foundation has enabled the paediatric intensive care unit (PICU) to purchase two PrismaFlex machines, specifically designed to provide a form of continuous dialysis within the ICU environment for critically ill children experiencing kidney failure.

“Our team members are highly engaged and always willing to go above and beyond to help our patients.”DR. SHAUNA BURKHOLDER,

MEDICAL DIRECTOR,

CRRT PROGRAM


Celebrating the successes of our trainees

The following General Paediatrics residents were recognized in 2018 for their accom-plishments in clinical practice, research, and more.

DR. STACY YEH

Canadian Paediatric Society (CPS) Emerging Professional in Child Maltreatment Grant

DR. RAISA KANJI

(co-authors Dr. Nipunie Rajapakse and supervisor Dr. Joseph Vayalumkal)Dr. Susan King Paediatric Abstract Award

DR. SYEDA ABBAS

Professional Association of Resident Physicians of Alberta (PARA) Resident of the Month Award for October 2018

DR. RENEE FARRELL

University of Calgary 2018 Helios Scholarship Award


A second type of organ dona-tion process, called Donation after Cardiocirculatory Death (DCD), expands donation eli-gibility to patients who have experienced circulatory death, meaning their hearts have per-manently stopped beating following planned withdrawal of life-sustaining therapies. This process is much more time-sen-sitive. When the heart stops, the donor patient is trans-ported to the operating room just minutes after death to have organs recovered, which may include the lungs, kidneys, and liver. Tissues can also be recov-ered with this procedure, which may include the corneas and/or heart valves, depending on the donor patient’s age and size. In the past, this second option was not available for families of chil-dren at the Alberta Children’s Hospital, and there was no pae-diatric DCD program existing in Alberta. During that time, it was very difficult for the team in the paediatric intensive care unit (PICU) to say no to families facing a tragic loss who wanted to donate but whose child didn't meet the criteria for brain death.

Change occurred in 2016 following one family’s traumatic loss, when they urged the PICU team to find a way to allow

organ donation for their child and create a positive legacy from their tragedy. The patient did not meet the traditional eligibility criteria for organ donation and normally they would have required transfer to Ontario for the DCD procedure to take place. Instead, the PICU team saw an opportunity for change. While the early ground-work for program development was ongoing, there was not yet a formal protocol for DCD at the Alberta Children’s Hospital. Leadership within Alberta Health Services and the Alberta Children’s Hospital, together with the Southern Alberta Organ and Tissue Donation Program, fully supported the rapid establishment of such a program. The entire team rehearsed all of the required steps and worked throughout the night to prepare for this first case. With magnanimous cooperation and collabora-tion between various groups, including but not limited to the PICU, Southern Alberta Organ and Tissue Donation Program, transplant team, anesthe-sia, the operating room staff at both the Alberta Children’s Hospital and the Foothills Medical Centre, nursing, respi-ratory therapy, site leadership,

and the Critical Incident Stress Management (CISM) team, the DCD program was established within 48 hours and the team at the Alberta Children’s Hospital was able to facilitate the dona-tion of the patient’s kidneys and liver. The DCD program at the Alberta Children’s Hospital is currently the only formal pae-diatric program of its kind in western Canada and regularly conducts multidisciplinary sim-ulation sessions of the entire process with support from KidSIM, a world-class simu-lation facility at the Alberta Children’s Hospital, with donor coordinators, nurses, respiratory therapists, and surgeons as part of ongoing learning and collab-oration for all clinicians involved.

Research has shown that the process of organ donation can drastically change the grieving process for families, providing them with a glimmer of hope – however small it may seem at the time – that their unimag-inable loss may save another child’s life. “Organ and tissue donations are life-changing, both for the recipients and for the families left behind after a heartbreaking loss,” explains Dr. Meagan Mahoney, who co-directs organ and tissue donation at the Alberta Children's Hospital with Laurie Lee, a nurse practitioner in the PICU. The PICU team has received positive feedback from families who have participated in organ donation, with many reporting that the opportunity for their child to be an organ donor has given them some-thing positive to hold onto.

“For us, this is about what we can do when we have nothing left to give these families besides a peaceful death,” explains Mahoney. “We are taking care of the families who are right in front of us, helping them find meaning in their child’s life and legacy, and possibly helping them in their bereavement process going forward.”

Establishment of the DCD program has transformed the culture surrounding organ and tissue donation throughout the Alberta Children’s Hospital and has led to the creation of the Alberta Children’s Hospital Organ and Tissue Donation Oversight Committee. The PICU continues to be active in promoting and maintaining a culture of donation that is spreading throughout the hos-pital, ensuring that every family is offered potential organ and tissue donation opportunities as an essential part of excellent end-of-life care at the Alberta Children’s Hospital. The Alberta Children’s Hospital Organ and Tissue Donation Oversight Committee maintains this as their overarching goal. “The culture shift within the PICU and throughout the hospital has been amazing in advocating for families who wish to participate in organ and tissue donation,” says Mahoney, explaining that the final hours of a patient’s life and the end-of-life process remain the same in all situa-tions, whether organ donation is an option or not. Nursing staff throughout the hospital have become champions and advocates for organ and tissue donation, with continuing education on the importance

of donation for both the recip-ient’s family and the donor’s family. Growing awareness of the program has stimulated a significant amount of discus-sion about organ donation with patient families and health-care providers. Now if a child dies within the PICU or neona-tal intensive care unit (NICU), information about organ and tissue donation is discussed with the patient’s family.

“It has completely changed how I think about end of life,” says Mahoney of the oppor-tunity to be a part of building such a program at the Alberta Children’s Hospital. Mahoney has participated in a nation-wide collaborative process to develop the Canadian Guidelines for Controlled Paediatric Donation after Circulatory Determination of Death. She is also part of an ongoing national collaboration in the development of Canada-wide guidelines for care of the organ donor, both in paediatrics and adult medicine.

To date, three patients at the Alberta Children’s Hospital have become organ donors through the DCD program since its implementation – patients who would not have been eligible for organ donation before the DCD program existed – which has led to more than six lives saved.

CONTRIBUTORS

Dr. Meagan Mahoney, Laurie Lee

The transformative power of organ donation for families and health-care providersUntil 2016, the only way for organ donation to proceed at the Alberta Children’s Hospital was following neurological death in a patient, when the brain has permanently lost all function. When brain death is declared, all of the organs can potentially be donated.

“Organ and tissue donations are life-changing, both for the recipients and for the families left behind after a heartbreaking loss.”DR. MEAGAN MAHONEY,

CO-DIRECTOR,

ORGAN AND TISSUE DONATION,

ALBERTA CHILDREN'S HOSPITAL

Organ donation in Canada

The vast majority of Canadians support organ and tissue donation and growing awareness has stimulated a significant amount of discussion about the importance of donation for both the recipient’s family and the donor’s family.

78PATIENTS

119

1

TRANSPLANTS

ORGAN DONOR

1,600CANADIANS

1 organ donor can help up to 75 people and save up to 8 lives

1,600 Canadians are added to the wait-list for an organ transplant each year

119 paediatric organ transplants completed in Canada*

78 paediatric patients on the wait-list for a life-saving organ transplant in Canada*

RECOGNITION

Dr. Vincent Grant, Medical Director of KidSIM and associate professor with the Departments of Paediatrics and Emergency Medicine, was a

recipient of the 2018 Canadian Association for Medical Education (CAME) Certificate of Merit Award, recognizing his commitment to medical education.

* Canadian Institute for Health Information (CIHI) as of December 31, 2017.


“This program started with a lot of stakeholder input from Alberta Health Services, the Department of Paediatrics at the University of Calgary, and our partners in Edmonton,” explains Samuel. Funded by the Canadian Institutes of Health Research, Alberta Health Services, the Alberta Children's Hospital Foundation and the Stollery Children's Hospital Foundation in Edmonton, the Transition Navigator Trial is currently recruiting study participants and hopes to enroll 600 indi-viduals aged 16 to 21 over the next two years across its three participating sites, the Alberta Children’s Hospital, the Stollery Children’s Hospital, and the Glenrose Rehabilitation Hospital. Co-leads for the project include Dr. Gina Dimitropoulos at the University of Calgary and Dr. Andrew Mackie at the University of Alberta.

In Calgary, any patient with a chronic disease who has received paediatric care at the Alberta Children’s Hospital and is approaching transition to adult health care is eligible for participation in the Transition Navigator Trial. Study par-ticipants are randomized for inclusion in either the interven-tion group which ensures access

to a patient navigator or the control group which proceeds with the standard clinic proto-cols for transition. The patient navigator follows an individual’s journey upon leaving paediatric care and up to two years follow-ing their transfer to adult care. At the Alberta Children’s Hospital, this process begins with a pre-liminary assessment by patient navigator Jennifer Schroeder, who meets with the patient and the patient’s family to identify areas of concern and address any socioeconomic factors that may impact their transition, including finances, transportation, funding eligibility, housing, and social supports. “It is our job to ensure that the patient and family have everything they need to feel comfortable in the transition,” explains Schroeder, one of two provincial patient navigators for this project along with her coun-terpart at the Stollery Children’s Hospital in Edmonton. Part of this process includes setting goals generated by the partic-ipants themselves, outlining their requirements for a suc-cessful transition to adult health care. “We teach patients how to advocate for their own needs, encouraging independence and self-management as they adapt to the adult health-care system.”

The intervention is individual-ized to the patient and support may be focused on a variety of areas, such as how the individ-ual will be managed medically or the resources they will require to attend post-secondary edu-cation. “Some children with chronic health conditions lose funding for certain services at age 18, so we need to figure this out with them,” explains Samuel. “There are also certain treatments or ways of doing things in paediatrics that have no such equivalent in adult med-icine, so we work together with adult health-care providers to find appropriate solutions for the patient.” Navigation support also helps patients in manag-ing long wait-lists and ongoing appointments within the adult system, learning to recite their medical history to future health-care providers.

BRIDGING THE GAP

From hospital to community

Providing support for our patients can be part of an ongoing journey, such as assisting with transition to adult health care when they reach 18 years of age and are no longer consid-ered ‘paediatric.’ The care we provide also includes supporting new and/or vulnerable populations such as refugees, low-in-come families, child abuse victims, and street involved youth. The Department of Paediatrics has several pro-grams in place, from broad scope to discipline-specific, that are focused on guiding patients throughout their health-care journeys, both in the hospital and within our communities.

Living our Values Through Collaboration

In the fall of 2018, Dr. Susan Samuel was selected as the new Director of the Canadian Child Health Clinician Scientist Program

(CCHCSP), a transdisciplinary training program for the next generation of clini-cian-scientists in child and youth health research in Canada.

CONTRIBUTORS

Dr. Susan Samuel, Jennifer Schroeder

Evaluating the impacts of a patient navigator service on transition to adult careTransitioning to the unfamiliar world of adult health care can be stressful and daunting for youth with chronic health conditions. Led by paediatric nephrologist Dr. Susan Samuel, a new provincial initiative called the Transition Navigator Trial aims to evaluate the impact of a patient navigator service to help coordinate the transition of patients to adult care across our province.

“It is our job to ensure that the patient and family have everything they need to feel comfortable in the transition.”JENNIFER SCHROEDER,

PATIENT NAVIGATOR,

ALBERTA CHILDREN’S HOSPITAL


One such example is the Sleep Transition Clinic, led by Dr. Adetayo Adeleye, paediatric respirologist and sleep physician, and Dr. Sachin Pendharkar, adult respirologist and sleep physician. Sleep disorders are a growing health concern in children and may include sleep apnea, diffi-culty initiating or maintaining sleep, parasomnias, or narco-lepsy. Over the years, it has become increasingly apparent that more paediatric patients require ongoing sleep care into adulthood. Secondly, the previ-ous model of patient transition

– comprised of a referral to the adult sleep centre followed by a lag time before consulta-tion – was not working well with several patients never receiving follow up. Confronted with these challenges, the sleep centres at the Alberta Children’s Hospital and Foothills Medical Centre recognized the need to develop a multidisciplinary program with the aim of coordinating and improving patient transition. The team consists of physicians, reg-istered respiratory therapists, nurses, and polysomnographic technologists who perform sleep studies at the Alberta Children’s Hospital, coupled with extensive collaboration with

their adult sleep medicine coun-terparts at the Foothills Medical Centre. Sleep Transition Clinics are now held every six months at the Alberta Children’s Hospital, the “medical home” for these patients, involving both paedi-atric and adult sleep physicians and allied health-care providers. Follow up care is determined on a case by case basis, which may include continual testing or regular appointments at the Foothills Medical Centre, or dis-charge back to a family physician for ongoing care. This has been a welcome program for fami-lies of paediatric patients and a rewarding initiative for the allied health-care providers involved.

Another example of a suc-cessful transition program at the Alberta Children’s Hospital is the Clinic for Turner Syndrome, which is led by paediatric endocrinologists Dr. Daniele Pacaud, Dr. Josephine Ho, and Dr. Rebecca Perry. Most people have two sex chro-mosomes - males have one X and one Y chromosome, while females have two X chromo-somes. Turner syndrome is a rare genetic condition in females that occurs when one of the X chromosomes is missing, par-tially missing, or altered.

The condition may result in a variety of medical and devel-opmental issues ranging from subtle to readily apparent, including but not limited to hormone imbalances, stunted growth, heart and/or kidney defects, and loss of ovarian function. A dedicated clinic at the Alberta Children’s Hospital has helped to ensure that patients with Turner syndrome receive consistent follow up care, including regular comprehen-sive screening and assessments. The multidisciplinary clinic has increased consistency in applying the latest guidelines in care man-agement for individuals with this lifelong condition, streamlining follow up care, providing hor-monal support, and facilitating referrals to an adult endocrinol-ogist once the patient reaches age 18. The clinic also provides access to family resources and support groups, as well as peer support for both children and parents to exchange information and experiences. Furthermore, Dr. Rebecca Perry regularly conducts outreach educational sessions for families, increasing awareness and visibility of this diagnosis within our local communities.

Many individuals who are tran-sitioning to adult care do not have family doctors, so this program helps to coach them through this process. “We recommend that these patients use their family doctor when-ever possible, and get them comfortable with under-standing and speaking about their own health conditions,” explains Samuel. The Transition Navigator Trial maintains a family-centred approach, con-necting patients and families with helpful resources and community-based programs to promote a successful transi-tion while providing emotional support for families with depen-dent children as needed.

As a patient navigator, Schroeder keeps in frequent contact with patients to catch any potential problems that may arise throughout the transition period and afterwards, provid-ing individualized support and active follow up as needed to ensure that patients are adher-ing to recommended protocols.

“Often times, medical care can be substantially sabotaged when other parts of a patient’s life are falling apart,” says Schroeder, which may arise from doing poorly in school, strug-gling with addictions, or battling mental health issues such as depression or anxiety. “We really try to take a holistic approach with this program and integrate patient-centred solutions.

If the rest of the patient’s life is going well, they are more likely to follow through with medical care.” Every three months, the team does a chart review of the patient’s electronic medical record, speaking with health-care providers involved in their care as needed. “We are advocates for these patients in helping them navigate the world of adult health care,” explains Samuel.

To date, over 100 patient referrals have been completed at the Alberta Children’s Hospital, with nearly 100 additional refer-rals completed at the Stollery Children’s Hospital in Edmonton. The volume of referrals is increasing from all disciplines, with the team currently receiv-ing four or five new referrals each week. “We are hoping to have between 100-150 patients in the program at any one time,” says Samuel. “This has been an incredible partnership between Edmonton and Calgary.”

LEFT: Patient navigator Jennifer Schroeder meets with patients at the Alberta Children’s Hospital as they transition to adult health care, following their journey after leaving paediatric care and for up to two additional years.

CONTRIBUTORS

Dr. Adetayo Adeleye, Dr. Carol Huang, Dr. Daniele Pacaud, Dr. Josephine Ho, Dr. Rebecca Perry

Discipline-specific transition programsThe transition from youth to adulthood can be challenging for anyone, and especially so for individu-als with chronic health conditions. Fortunately, many of the individual clinics at the Alberta Children’s Hospital have their own unique programs to assist patients in their transition from paediatric to adult care.

“We are advocates for these patients in helping them navigate the world of adult health care.”DR. SUSAN SAMUEL,

PROJECT LEAD,

TRANSITION NAVIGATOR TRIAL


LOCATION

Southeast, Calgary

MONDAY South Health Campus

Mondays are typically flex days for Forbes. Sometimes she will use this time to catch up on overflow from the week before, such as charting or making a call to the hospi-tal to ensure they received a referral for a baby that needs to be seen. Other times she has no clinical duties and is able to use this day for meetings or to catch up on those mundane but necessary tasks, such as laundry or running errands.

Eight weeks per year, however, Forbes is on 24-hour call at the South Health Campus from Monday to Sunday. As the paediatrician on-call, Forbes visits the postpartum unit and checks on all of the newborns. “For the most part, I examine the baby and give my con-gratulations to the family,” says Forbes, who describes this as the most enjoyable, lighthearted part of her practice. She keeps her phone with her at all times and when she is finished at the hospital, the unit nurses may contact her if there are concerns with any of the newborns, and the midwives or family physicians who deliver the babies may call to request her opinion on specific cases. The unit is a very collaborative place to work – if a case is urgent and Forbes is offsite, her neonatology colleagues from the neonatal intensive care unit (NICU) are available to see a baby promptly.

“I knew I wanted to see newborns as part of my practice, and the new hospital opened just as I was finishing my resi-dency,” explains Forbes, noting that she happened to be the first paediatrician to do rounds on the postpartum unit at the South Health Campus in November 2012.

“You really get to direct your career in community paediatrics.”

CONTRIBUTOR

Dr. Natalie Forbes

A Week in the Life of a Community Paediatrician

Dr. Natalie Forbes always knew she wanted to be a doctor, but shelved that dream when she felt her post-secondary grades weren’t high enough to get into medical school. When the timing was right, she made the decision to revive her lifelong dream, successfully writing her MCAT exam and enrolling in medical school at the University of Calgary, now the Cumming School of Medicine, at age 34.

Now a community paediatrician and mother of two, each day is different and filled with its own triumphs and chal-lenges. Mornings start early at around 5:00 am when, like many busy physi-cians, Forbes sneaks in time for personal wellness with a workout or run. After dropping her daughter off at university, it’s off to work for the day.

The Section of Community Paediatrics is the largest section within the Department of Paediatrics, comprised of over 70 community paedi-atricians who work throughout Calgary’s

four quadrants and beyond, including Cochrane, Okotoks, and Canmore. Like many members of the section, Forbes enjoys ample variety in her work, which includes time spent at the South Health Campus, the Sheldon Kennedy Child Advocacy Centre, her community clinic at the East Calgary Health Centre, and the Mosaic Refugee Health Clinic.

Here is a snapshot of a typical work week for Forbes.

NWNE

SW

SE


The Department of Paediatrics has a diverse presence at the South Health Campus.

In addition to eleven community paediatricians who provide newborn care on the post-partum unit, numerous depart-ment members, including pae-diatricians and subspecialists, provide care throughout the hospital for patients in the neonatal intensive care unit (NICU), asthma clinic, and emergency department. Two paediatricians, Dr. Nadira Rashid and Dr. Adel El Sharkawy, also provide general paediatric out-patient clinics at the South Health Campus with over 1,700 patient visits last year.

RECOGNITION

Dr. Harish Amin, neonatologist and paediatric Medical Site Lead at the South Health Campus, was the recipient of the 2018 International Collaboration

Award from the Royal College of Physicians and Surgeons of Canada for his leadership in advancing post-graduate medical education.

38 Department of Paediatrics 2018 Annual Report 392018 Annual Report 39

LOCATION

Southeast, Calgary

WEDNESDAY East Calgary Health Centre

Forbes works at the Children’s Health Clinic at the East Calgary Health Centre in southeast Calgary three days per week, from Wednesday to Friday. She is one of five community paediatricians who are working at the clinic, including Dr. Heidi Angeles, Dr. Thiru Govender, Dr. Faruqa Ladha, and Dr. Stephen Wainer. These physicians see a wide variety of patients, from premature babies to children up to age 18. Medical conditions seen at the clinic range from straightforward to highly complex, such as patients with heart problems or post-transplant follow ups. Forbes started working here in 2016, and typically sees about ten patients per day, including new consults and follow ups. Common issues at the clinic include attention deficit hyperactive disorder (ADHD), speech language delays, cog-nitive/developmental delays, and follow ups after a child’s visit to the emergency department to ensure they are recovering as expected. Children in foster care who are referred to a paediatrician through the Paediatrics for Kids in Care (PKIC) program are also seen at this clinic.

The patient population is highly diverse with a wide variety of cultural backgrounds, and many families who visit the clinic are in a vulnerable eco-nomic position. “I moved my practice

to Forest Lawn because I wanted to focus on this vulnerable sector,” explains Forbes, noting that the clinic is the main catchment for paediat-ric patients in east Calgary. The East Calgary Health Centre is part of the Mosaic Primary Care Network, which provides access to a wide range of patient and family resources such as social workers, behavioural health con-sultants, dietitians, and kinesiologists. Through this network, paediatricians also have access to the language line which acts as a translation service allow-ing the physician to communicate with patients and families who speak other languages. Furthermore, the Children’s Health Clinic is closely linked with the Family Care Clinic at the same location, providing an opportunity for regular referrals and collaboration between family physicians and paediatricians.

LOCATION

Northwest, Calgary

TUESDAY Sheldon Kennedy Child Advocacy Centre

On Tuesdays, Forbes is at the Sheldon Kennedy Child Advocacy Centre (SKCAC) located across from the Alberta Children’s Hospital. Forbes joined the team in July 2016 and is one of three Child Abuse physicians who work at the SKCAC, together with Dr. Jennifer MacPherson and Dr. Jenn D’Mello. The physicians work pursuant to an inte-grated model of care, including Alberta Health Services (physicians, nurses, and therapists), the Calgary Police Service, Children’s Services, the RCMP, and Victim Support. In the morning, the partners meet to triage new cases. “We determine what has to be done for each case and who is going to quarterback it,” explains Forbes. Following triage, the physicians come together to run through all of the cases currently being managed, which may include telehealth meetings with rural sites. Each of the physicians is on-call every third week for one week at a time, which involves seeing patients in the paediatric intensive care unit (PICU) and inpatient units at the Alberta Children’s Hospital. During this time, the physician on-call can also be consulted via phone 24/7 by local and rural sites within central and southern Alberta with any questions or concerns regarding suspected child abuse. In the afternoon, Forbes performs medical examinations on infants, children and youth who are suspected victims of abuse.

RECOGNITION

Community paedi-atrician Dr. Lauren Redgate was the recipient of the Excellence in Clerkship Teaching Award from the Undergraduate Medical Education program at the Cumming School of Medicine. She was named as one of the top ten out of a total of 1,235 evaluated clinical preceptors, placing her in the top 99+ percentile of clinical teachers.



LOCATION

Northeast, Calgary

THURSDAY Mosaic Refugee Health Clinic

Clinic in the morning at the East Calgary Health Centre, a quick lunch while charting, and then it’s off to the Mosaic Refugee Health Clinic at Marlborough Mall in northeast Calgary. The Mosaic Refugee Health Clinic provides essential medical care and other health services to newcomers who arrive in Canada as refugees. Forbes is one of three commu-nity paediatricians who work at the clinic, together with Dr. Thiru Govender and Dr. Sangeeta Jain. Here, Forbes typi-cally sees 3-5 patients over the course of the afternoon. “I see everything from straightforward medical issues to very complex developmental problems, and some conditions we wouldn’t normally see here in Canada,” explains Forbes. An example of such a condition is phenylke-tonuria (PKU), which is largely unheard of in North America due to early screen-ing and treatment. Families often do not have access to such screening in devel-oping countries and left untreated, the condition can lead to profound develop-mental delays. “Many of the children we see have been in a refugee camp for their whole lives and have never seen a doctor,” explains Forbes, noting that the families accessing the clinic are generally incred-ibly grateful to receive medical attention. The clinic provides support to families for up to two years following their arrival

in Canada with access to additional resources including social work, mental health support, and transition services, helping to connect patients with family physicians in their communities for ongoing care.

Forbes describes communication as one of the biggest challenges at the clinic, as there is no cultural equivalent for some commonly seen conditions, such as autism, in other countries. As part of the Mosaic Primary Care Network, the phy-sicians have access to the language line and speak through a translator, enabling them to communicate with the patient and family throughout the visit or phys-ical examination. “Communication is everything in medicine, so this can be very challenging,” explains Forbes. “It really makes you focus on the essentials.” For example, discussions with patients and families assist in developing medical literacy about a variety of health topics, from simple to complex. “As doctors, we tend to get caught up in our medical jargon, using common idioms that we don’t even think about,” explains Forbes.

“One of the advantages of coming into medicine later is that I am not as deeply ingrained in that medical jargon. I still remember what it’s like to think as a non-medical person.”


LOCATION

Southeast, Calgary

FRIDAY East Calgary Health Centre

Forbes is back working at the Children’s Health Clinic at the East Calgary Health Centre. The clinic is also a teaching site for medical students from the Undergraduate Medical Education program at the Cumming School of Medicine, University of Calgary. “I teach residents and students in all areas of my practice,” explains Forbes. “If there is an opportunity in your residency to rotate through different areas of medi-cine, that is great! Just keep in mind that while you get to see the medical side of the picture as a trainee, you aren’t yet privy to the business or administrative side,” explains Forbes. “I worked with Dr. Nathan Chan in the last year of my residency and he told me, ‘Whatever you think you want to do, start with half.’ There’s only so much time in a day, and that’s the struggle for all community paediatricians. We’re running a busi-ness.” Forbes also prioritizes the impor-tance of ongoing education, even for staff physicians. “I am now six years into my career and I still look to other physicians for mentorship. It never ends, there are always new things to learn.”

After wrapping up her work days, Forbes typically gets home around 5:00 pm to spend quality time with her family. “Maybe it’s an illusion, but I feel I have things under control when it comes to work-life balance,” laughs Forbes, explaining that she is very vig-ilant about not getting behind during the day, preferring to chart through her lunch break rather than working late.

“I didn’t want my work to creep into my personal life, so I really had to create those boundaries.”

Her advice for those looking to expand their horizons: “If you are curious about a certain area, I think the key is to find an opportunity that allows you to try it out without committing to permanence. Make sure you’re fully ready before taking on something new,” explains Forbes, adding that for her, variety in her practice and the ability to work with vulnerable populations throughout Calgary is very important. “Each area of my practice informs the others, and I feel I’m a better physician because of that,” explains Forbes. “My kids always tell me that I have four jobs. It’s busy, but I wouldn’t know which one to let go. I love each part of my work for different reasons.”

UPDATE

It’s 10:00 am on Monday morning.

A 17 year old girl walks through the doors of the medical clinic.

She hesitantly fills out the questionnaire we provide.

I sense how nervous she is to be here, and assure her that everything will be kept 100% confidential.

I ask her why she is visiting the clinic today.

Shaking, she rolls up her sleeves to expose a number of angry sores on her fore-arms, appearing to be cigarette burns that have become infected.

I reassure her that she has come to the right place, and ask if she has a safe, warm place to stay and something to eat.

For the first time, her eyes meet mine.

She looks at me, helpless, as a small child in trouble would look at an adult.

Tears well in her eyes.

She has nowhere to go.

No one she feels she can turn to.

And the one person she thought she could trust has physically abused her.

We sit together in silence as she cries.

It is in this moment that the healing begins…

The new campus of Woods Homes opened in early 2018, located in the central Calgary community of Inglewood. It houses a number of integrative youth services, including the Calgary Adolescent Treatment Services (C.A.T.S.) Clinic, a medical clinic for street involved youth now in its twelfth year of partnership with the Woods Homes’ Street Services program.

“Over a decade ago when I was seeking a partner for a clinic that would provide medical care for street involved youth, I knew immediately that Woods Homes was the perfect fit,” says Dr. April Elliott, Section Chief of Adolescent Medicine in the Department of Paediatrics.

“Their motto says it all: ‘We Never Say No. We Never Give Up. We Never Turn Anyone Away.’”

CONTRIBUTOR

Dr. April Elliott

Calgary Adolescent Treatment Services (C.A.T.S.) Clinic moves to new campus of Woods Homes


Within the Department of Paediatrics, third-year residents are provided with an opportunity to learn about social paediat-rics, including rotations at the Sheldon Kennedy Child Advocacy Centre (SKCAC), Paediatrics for Kids in Care (PKIC), and the Mosaic Refugee Health Clinic. With less of a focus on medicine and greater emphasis

on understanding the barriers that vulnerable families are facing in our communities, this mandatory rotation allows our trainees to learn about the importance of the social deter-minants of health

– the conditions in which people are born, grow, work, live, and age that influence individual and population health.


Within the Department of Paediatrics, our teams have embraced a “culture wave” towards a collaborative quality improvement initiative to elim-inate preventable patient harm throughout the Alberta Children’s Hospital. Together with the Stollery Children’s Hospital in Edmonton, the Alberta Children’s Hospital has joined the Solutions for Patient Safety (SPS) National Children’s Network, a collaborative effort of over 135 children’s hospitals across North America to elimi-nate preventable patient harm. Within this network, partner-ing sites work together to share best-practices and learnings in optimal care delivery to help achieve the collective goal of eliminating serious harm and hospital acquired conditions (HACs) – avoidable injuries or events that occur within the four walls of the hospital – for all paediatric patients and staff.

The name of this program, “Safest Together,” was chosen by patient and family advi-sors. Safest Together combines

participation in the SPS network with other high reli-ability patient safety initiatives within the Alberta Children’s Hospital, such as implemen-tation of a paediatric early warning score. Site-wide edu-cation on error prevention methodologies will be imple-mented for all staff working at the Alberta Children’s Hospital and Stollery Children’s Hospital, under the guiding principle that our patients are safest when we work together. Through the utilization of patient data col-lection and evidence-based practices from the SPS network, Safest Together has begun implementing high-impact inter-ventions. These interventions aim to reduce the rates of pre-ventable harm to zero at each of Alberta’s two children’s hos-pitals. Central to our values and the work being done across the Alberta Children’s Hospital, Safest Together will embrace a family-centred approach, ensur-ing maximum engagement from both patients and their families as key partners in achieving this

important goal. As part of this initiative, participating sites will report individual successes and learnings back to the greater SPS network to be shared amongst all member hospitals in North America.

RECOGNITION

The Commitment to Comfort Quality Improvement Collaborative Team led by Dr. Jennifer Thull-Freedman, Medical Director of Quality and Safety at the Alberta Children’s Hospital, received an Alberta Health Services President’s Excellence Award for Outstanding Achievement in Quality Improvement. Thull-Freedman

was also the recipient of the Top Quality Improvement & Patient Safety (QIPS) Abstract Award at the Canadian Association of Emergency Physicians 40th Annual Conference for her project entitled: “Improving the pain experi-ence for children with limb injury: A city-wide quality improvement collaborative.”

AND BEYOND

Improving safety and quality of care at the Alberta Children’s Hospital

A primary focus within the Department of Paediatrics is identifying novel ways to enhance health care deliv-ery and patient outcomes. With a growing culture of safety and a focus on opti-mizing quality, our teams are constantly raising the bar, identifying areas for improvement and innova-tive means to provide the best care possible for our patients and families.

Solutions for Patient Safety (SPS) National Children’s Network

Since 2012, over 135 children’s hos-pitals across North America have joined the Solu-tions for Patient Safety network with a shared goal to eliminate pre-ventable patient harm. As of July 2018, this collab-orative effort has saved over 10,206 children from serious harm and led to cost savings of more than $173 million across par-ticipating sites.

135$173M

10,206 PARTICIPATING CENTRES

ESTIMATED SAVINGS

CHILDREN SAVED FROM SERIOUS HARM

CONTRIBUTORS

Dr. Mark Anselmo, Dr. Jennifer Thull-Freedman

Safest Together: Prioritizing patient safety through collaborationAn important component of optimizing care is ensuring that patient safety is paramount. From frontline clinicians to administration and beyond, each and every staff member across our hospital plays an important role in helping to keep our patients safe.


In fact, the World Health Organization (WHO) has declared antimicrobial resistance as one of the greatest threats to human health, predicting that without effective action, it will surpass cancer as the leading cause of death worldwide by the year 2050.

A coordinated effort to promote appropriate use of antimicrobials, called anti-microbial stewardship, is of utmost importance in the battle against over-prescribing and misuse. A team at the Alberta Children’s Hospital has priori-tized antimicrobial stewardship, spearheading a number of projects to help educate pre-scribers and improve patient outcomes across the hospi-tal. “Our overall aim with this program is to optimize clini-cal outcomes while minimizing any unintended consequences, including antimicrobial tox-icity and the emergence of resistance,” explains Dr. Cora Constantinescu, paediatric infectious diseases specialist and Lead of the Antimicrobial Stewardship Program at the Alberta Children’s Hospital. One of the platforms used to promote stewardship at the Alberta Children’s Hospital is Spectrum, an innovative app aimed at helping clinicians

choose the appropriate anti-microbial based on integrated algorithms and clinical path-ways. Originally conceptualized by adult infectious disease res-idents Dr. Elizabeth Parfitt and Dr. Paul Campsall in Calgary, the easy-to-use app helps guide the user through complex clin-ical decision-making using a step-by-step platform. With support from the Department of Paediatrics, Constantinescu and former paediatric infec-tious diseases fellow Dr. Nipunie Rajapakse developed a version of the Spectrum app specific to the Alberta Children’s Hospital, adding numerous antimicrobial guidelines that were applicable and relevant to our patient pop-ulation. The Alberta Children’s Hospital was the first paediat-ric hospital to join the Spectrum app and the third health-care site overall. “It’s not just about telling our clinicians what drug works with what bug,” says Constantinescu. “We want to support our teams in determin-ing the diagnosis and then help them choose the appropriate antimicrobial for the specific clinical presentation, based on the severity of the condition and our local susceptibility patterns.” Susceptibility and prevalence of specific pathogens varies based on location, meaning that the

Alberta Children’s Hospital has its own unique antimicrobial ‘spectrum’ that differentiates it from other hospitals locally, nationally, and internation-ally. “The Spectrum app is supposed to be local, so every hospital should have distinc-tive guidelines based on where they are located,” explains Constantinescu. “The whole point of stewardship is that it’s tailored, so you may not be able to apply the same rules every-where.” For example, while the international treatment guide-line for influenza recommends various antivirals, some are not available for children or may only be available through special access requests. For this reason, the Antimicrobial Stewardship Program team collaborates with its inpatient pharmacy at the Alberta Children’s Hospital to ensure that all antimicro-bial guidelines uploaded to the Spectrum app contain the most current and locally rele-vant information for our unique patient population. User feed-back from our site has been very positive to date – the app now has over 250 monthly users and more than 800 monthly sessions across the Alberta Children’s Hospital, with variations from season to season.

The Antimicrobial Stewardship Program team also runs an innovative compe-tency-based medical education curriculum for paediatric infec-tious disease residents that is focused on antimicrobial stewardship. Based on the

“Core Elements of Antibiotic Stewardship for Hospitals” from the Centers for Disease Control and Prevention in the United States, the curriculum ensures that physicians develop skills that are internationally relevant and can be applied anywhere around the globe. As part of this curriculum, residents have the opportunity to participate in hands-on stewardship and

prospective audit and feed-back for prescribers, as part of identifying long-term solu-tions to combat the growing issue of antimicrobial overuse and misuse. “Stewardship is not just about using the nar-rowest spectrum. It’s about helping health-care workers make the right choices to opti-mize treatment for patients,” explains Constantinescu. The Antimicrobial Stewardship Program is “small but mighty” says Constantinescu, who has presented various abstracts at national and international meet-ings related to the antimicrobial stewardship education initia-tives at the Alberta Children’s Hospital. Furthermore, the team frequently collaborates with the Infection Prevention and Control (IPC) team at the Alberta Children’s Hospital. Dr. Joseph Vayalumkal, paediat-ric infectious diseases specialist and Medical Officer for the IPC team, has taken the lead on developing and submitting documentation for antimicro-bial stewardship to be formally recognized as an “Area of Focused Competence" by the Royal College of Physicians and Surgeons of Canada.

Funding received from the Department of Paediatrics has also supported a six-month audit in partnership with the Alberta Children’s Hospital inpa-tient pharmacy and Pharmacy Clinical Practice Leader Deonne Dersch-Mills. The team has con-ducted qualitative, one-on-one interviews with prescribers on the paediatric inpatient units and the paediatric intensive care unit (PICU) as part of a needs assessment to look at antimicrobial use and individ-ual prescribing decisions of our health-care providers. Data analysis on the metrics of site-wide antimicrobial usage across the Alberta Children’s Hospital has been supported by the Foothills Medical Centre, where

a dedicated stewardship phar-macist has provided assistance to our paediatric stewardship team. The team aims to use this data to design targeted, point-of-care education for pre-scribing physicians, in addition to using the Spectrum app to track user activity and deter-mine which antimicrobials are most frequently used through-out the hospital. “We know our local susceptibility patterns and we know our patient population,” explains Constantinescu, noting that each antimicrobial steward-ship initiative highlighted above complements the others and helps the team further under-stand the needs of prescribers at the hospital. “Together, these projects will allow us to design highly tailored and relevant edu-cation to engage our health-care teams, with the ultimate goal of improving health outcomes for our patients.”

The Spectrum app is free to download and available for both iOS and Android devices: http://www.spectrum.md/

RIGHT: As Lead for the Antimicrobial Stewardship Program, Dr. Cora Constantinescu (right) collab-orates closely with Pharmacy Clinical Practice Leader Deonne Dersch-Mills (left) on various edu-cational initia-tives, such as the Spectrum app (below).

Living Our Values Through Innovation

The described antimicrobial stewardship initiatives at the Alberta Children’s Hospital have been funded through a Department of Paediatrics Innovation Award.

“This all goes to show how far departmental support can take you,” explains Constantinescu.

“Our department saw the value in these initiatives, and we wouldn’t have been able to do this without that support.”

CONTRIBUTORS

Dr. Cora Constantinescu, Dr. Joseph Vayalumkal

Optimizing antimicrobial use through evidence-informed initiativesOveruse or misuse of antimicrobials is a global health issue that has led to the emergence of resistance for certain pathogens. These multi-drug resistant microorganisms – aptly named ‘superbugs’ – render standard medications ineffective in treating infections caused by bacteria, viruses, parasites, or fungi.

“Our overall aim with this program is to optimize clinical outcomes while minimizing any unintended consequences, including antimicrobial toxicity and the emergence of resistance.” DR. CORA CONSTANTINESCU,

PHYSICIAN LEAD,

ANTIMICROBIAL STEWARDSHIP

PROGRAM

Antimicrobials

Antimicrobials – medicines that kill or stop the growth of microorganisms – are grouped according to the pathogens they act against. For example, antibiotics are used against bacteria and antivirals are used against viruses.


Internal drivers for this change included the desire to improve patient safety, promote con-fidentiality, support case discussion and develop mech-anisms that would support the translation of learning to patient care. Furthermore, external drivers arose from developments occurring within Alberta Health Services (AHS), the College of Physicians and Surgeons of Alberta (CPSA), and the Canadian Medical Protective Association (CMPA). The CATCH Rounds initiative reflects part of a collective goal throughout the Alberta Children’s Hospital to learn from patient safety incidents, clinical errors, and near-misses.

The new CATCH Rounds maintain the former model of in-depth review of patient cases with the addition of specific curricular elements includ-ing creation of a Just Culture, case presentation and anal-ysis using a range of quality improvement methodologies, small and large group discus-sions, synthesis of the “Catch of the Day,” and development of recommendations for transla-tion to patient care. The CATCH curricular model was initially created in late 2016 and tested

over a 14-month period during 2017-2018. The study was con-ducted by Dr. Suzette Cooke, Dr. Michelle Bailey, Dr. Sarah Hall and Dr. Julie Fisher, with research funding provided by the Royal College of Physicians and Surgeons of Canada.

“The CATCH initiative has been highly impactful in helping our section identify system gaps that could potentially lead to patient safety issues,” explains Dr. Gemma Vomiero, Section Chief of Hospital Paediatrics in the Department of Paediatrics. These gaps are catalogued and initiatives are prioritized accord-ingly. Since the launch of CATCH Rounds in September 2017, a total of 34 recommendations have been made. Six of these have been fully implemented by the Section of Hospital Paediatrics, one has been estab-lished as a site-wide project at the Alberta Children’s Hospital, and 15 more are in development within the section. “Ultimately, this has led to tremendous improvements in our delivery of safe patient care,” explains Vomiero, adding that this has all been achieved in a very sup-portive environment, enhancing teamwork and learning through-out the hospital.

RIGHT: Multidisci-plinary rounds are conducted daily on inpatient units at the Alberta Children’s Hospital using a family-cen-tred approach. These rounds are an important part of the patient care process and may include attending physicians, sub-specialists, trainees, nurses, and other allied health-care providers.

RECOGNITION

The article entitled “Justify Your Answer: The Role of Written Think Aloud in Script Concordance Testing” written by Dr. Alyssa Power, Dr. Suzette Cooke and Dr. Jean-Francois Lemay

was selected for inclusion in the

“Top 10 Articles of the Year” in Medical Education at the 2018 Pediatric Academic Societies (PAS) meeting. This article provides new insights into the assessment of clinical reasoning.

CONTRIBUTORS

Dr. Gemma Vomiero, Dr. Suzette Cooke

Improving quality and safety of patient care with CATCH RoundsThe Section of Hospital Paediatrics has created and piloted a new method for analyzing patient cases to support professional learning and identify system gaps. This new initiative, called Case Analysis and Translation to Care in Hospital (CATCH) Rounds, has replaced the traditional morbidity and mortality rounds at the Alberta Children’s Hospital.


OUR COMMUNITY OUTREACH

Red Deer

Stoney Nakoda Nation

Calgary

Lethbridge

Medicine Hat

Stoney Nakoda Nation

2 CLINICS

- General Paediatrics Eden Valley (1/month)

- General Paediatrics Morley (2/week)

Red Deer Community

3 CLINICS

- Diabetes & Endocrine (4)

- Genetics (9 – 12)

- Low Vision (1)

Medicine Hat Regional Hospital and Community

8 CLINICS

- Cystic Fibrosis (2)

- Diabetes & Endocrine (5)

- Genetics – Community (9-12)

- GI (5)

- Low Vision – Community (1)

- Nephrology (4-5)

- Neurology (4)

- Pulmonary (4)

Chinook Regional Hospital and Community

6 CLINICS

- Cardiology (9)

- Diabetes & Endocrine – Community (10)

- Genetics (12)

- GI (4)

- Low Vision – Community (1)

- Nephrology (4)

Intersectoral Partnerships – Calgary Community

6 CLINICS

- Calgary Adolescent Treatment Services – CATS/EXIT (1/week)

- Community Outreach of Paediatrics and Psychiatry – COPE

- Southern Alberta Clinic (SAC) Surveillance Program (20)

- Paediatrics for Kids in Care – PKIC

- Low Vision Clinic (Community) (1)

- Youth Health Outreach Program – YHOP (10-11) PILOT

91,774 77,274 at ACH 14,500 at SHC

9,024 Across all sites (excluding surgical and mental health admissions)

4,0663,179 NICU Admissions 887 PICU Admissions

370,384326,444 Face to Face Visits 43,940 Other (Telephone/Telehealth) Includes all ACH-owned ambulatory care visits at all sites. This total does not include the thousands of children seen every year by members of the department who are community-based paediatricians.

INPATIENT ADMISSIONS

EMERGENCY DEPARTMENT VISITS

CRITICAL CARE ADMISSIONS

OUTPATIENT VISITS

Fiscal Year 2017-2018Numbers in parentheses indicate the number of clinics per year unless otherwise specified.


DEPARTMENT OF PAEDIATRICS

University Faculty Appointments

Primary Appointments (337) Joint Appointments (68)

Adjunct/ Adjunct/ Clinical GFT Research Clinical GFT Research Academic Status Faculty Faculty Faculty Faculty Faculty Faculty

Lecturer 88 0 1 13 0 0

Assistant Professor 106 8 17 18 4 0

Associate Professor 53 30 5 8 11 0

Professor 5 21 3 2 10 2

Totals 252 59 26 41 25 2

There are 4 additional members with emeritus or honorary university appointments.

Alberta Health Services (AHS) Medical Staff Appointments

Primary AHS Paediatrics* 321

Supplementary AHS Paediatrics 50

*This number contains 22 part-time or full-time locums.

Department Organization and Leadership

Dean, Cumming School of Medicine University of Calgary

Zone Medical Director Calgary Alberta Health Services

Department Head PaediatricsDr. Jim Kellner to November 30, 2018

Dr. Mark Anselmo as of December 1, 2018

Deputy Head Clinical & Strategic AffairsDr. Michael Leaker

Deputy Head EducationDr. Ronald Anderson

Deputy Head Professional AffairsDr. Jennifer MacPherson

Deputy Head ResearchDr. Susanne Benseler to October 31, 2018

Dr. Brent Hagel (acting) as of November 1, 2018

Department ManagerWes Schreiber

Lead for Development of Research CapacityDr. Brent Hagel

Physician Lead for Safety and Chair of Quality Assurance CommitteeDr. Sharron Spicer

Medical Director of Quality and Safety, Alberta Children’s HospitalDr. Jennifer Thull-Freedman

AMHSP ControllerMarco Romanzin

Administrative Assistant to Department HeadKaren Croucher

Billing CoordinatorTammy Bouchard

Communications CoordinatorAlison Shepherd

Manager of Administrative ServicesAlanise Featherstone

Financial AnalystVincent Bali

Physician Affairs CoordinatorChantelle Cini

Physician Remuneration and Contract CoordinatorKaren Rudd

Program Manager, Child Health ResearchNicole Romanow

Research AssistantAshton Chugh

SECTIONS, DIVISIONS, UNITSAdolescent MedicineDr. April Elliott

Cardiology Dr. Kim Myers

Community Paediatrics Dr. Roxanne Goldade

Child Abuse Service, Social Paediatrics UnitDr. Jennifer MacPherson

Critical Care Dr. Simon Parsons

Developmental Paediatrics Dr. Pamela Veale

Emergency Medicine Dr. Angelo Mikrogianakis to November 30, 2018

Dr. Antonia Stang as of December 1, 2018

Endocrinology Dr. Carol Huang

Gastroenterology Dr. Steven Martin

Global Child Health Unit Co–Directors: Dr. Jen Brenner Dr. Jean–Francois Lemay Dr. Nalini Singhal

Hematology & Immunology/AllergyDr. Michael Leaker

Hospital Paediatrics Dr. Gemma Vomiero

Infectious Diseases Dr. Mireille LeMay

Medical Genetics Dr. Francois Bernier

Neonatology Dr. Thierry Lacaze–Masmonteil

Nephrology Dr. Julian Midgley to September 30, 2018

Dr. Silviu Grisaru as of October 1, 2018

Neurology Dr. Jong Rho

Oncology/Bone Marrow Transplant Dr. Victor Lewis

Palliative Medicine Dr. Marli Robertson

Respiratory Medicine Dr. Candice Bjornson

Sleep Medicine Dr. Adetayo Adeleye

Rheumatology Dr. Susanne Benseler

UME, PGME, CME PROGRAMS AND DIRECTORSUndergraduate Medical Education Dr. Susan Bannister

Postgraduate Medical Education General PaediatricsCo-Directors: Dr. Marielena DiBartolo Dr. Amonpreet Sandhu

Developmental Paediatrics Dr. Scott McLeod

Emergency Medicine Dr. Naminder Sandhu

Endocrinology Dr. Rebecca Perry

Gastroenterology Dr. Alfred Yeung

Hematology/Oncology/BMTDr. Greg Guilcher

Infectious Diseases Dr. Taj Jadavji

Medical Genetics Dr. Rebecca Sparkes

Neonatology/Perinatology Dr. Majeeda Kamaluddeen

Nephrology Dr. Lorraine Hamiwka

Neurology Dr. Aleksandra Mineyko

Respiratory Medicine Dr. Glenda Bendiak

Continuing Medical Education Dr. Julian Midgley

SITE LEADERS Paediatrics FMC Dr. Chris Lever

PLC Dr. Essa Al–Awad

RGH Dr. Darrell Palmer

SHC Dr. Harish Amin

NeonatologyACH Dr. Alexandra (Alixe) Howlett

FMC Dr. Amuchou Soraisham

PLC Dr. Essa Al–Awad

RGH Dr. Prashanth Murthy

SHC Dr. Belal Alshaikh

There are over 100 administrative assis-tants and staff, as well as research staff, who support the Department of Paediatrics at all University of Calgary and Alberta Health Services-Calgary Zone sites.

0

10

20

30

40

50

<35 35-39 40-44 45-49 50-54 55-59 60-64 65-69 >70

Department Demographics*Number of Members by Age Group (Years)

Male (38%) Female (62%) Total Average Age = 48 years*Includes primary appointees only.



ADOLESCENT MEDICINEDr. April Elliott

Dr. Monique Jericho (Supp)

Dr. Jorge Pinzon

Dr. Ellie Vyver

COMMUNITY PAEDIATRICS Dr. Hilda (Heidi) Angeles

Dr. Rachel Bond

❚ Dr. Carrah Bouma*

Dr. Alexandra (Alixe) Carter*

Dr. Ciara Chamberlain*

Dr. Nathaniel Chan

❚ Dr. Shirley Chan*

Dr. Caroline Chee

Dr. Amy Chow

Dr. Kate Culman

Dr. Kirsten Ebbert

Dr. Amanda Evans

Dr. Kristin Evashuk

❚ Dr. Renee Farrell*

Dr. Elsa Fiedrich (.75 Neonatology Supp)

Dr. Cody Flexhaug

❚ Dr. Ian Frankish*

Dr. Frank Friesen

Dr. Janis Friesen

Dr. Cara Gilman

Dr. Roxanne Goldade

Dr. Sivalingum (Thiru) Govender

Dr. Janice Heard

Dr. Hardally Hegde

Dr. Kathryn Hluchy

❚ Dr. Ernst Hoppenbrouwers

Dr. Keith Jorgenson

Dr. Michele Kalny

Dr. Cham-Pion Kao

Dr. Lori Kardal

Dr. Brian Kelly

Dr. Victoria Kendrick

Dr. Krystina Kiefer

Dr. Kelleigh Klym

Dr. Faruqa Ladha

Dr. Jennifer Landero

Dr. Alexander Leung

Dr. Christopher Lever

Dr. Linda Loovere

Dr. Vicky Mah

Dr. Laura Miles

Dr. Kathleen Mitchell

Dr. May Mones

Dr. Danielle Nelson

Dr. Jane Ng

Dr. Peter Nieman

Dr. Steven Olliver

Dr. Darrell Palmer

Dr. Viktoria Pankiv

❚ Dr. Billie Dawn Parsley

Dr. Jody Patrick

Dr. Melanie Purtzki

Dr. Asma Quadir

Dr. Laine Racher

❚ Dr. Michele Ramien

Dr. Nadira Rashid

Dr. Lioba Redel

Dr. Lauren Redgate

Dr. Elizabeth (Betty) Robinson

Dr. Daniel Ross

Dr. Candace Rypien*

Dr. Elizabeth Shyleyko

Dr. Pamela Stone

Dr. Tracy Taylor

Dr. Stephen Wainer

Dr. Lori Walker

Dr. Emery Weber

Dr. Byron Wong

❚ Dr. Monique Wright

Dr. John Wu

Dr. Douglas Yeung

Dr. Desiree Yow

Dr. Shaila Zaver*

COMMUNITY PAEDIATRICS + CHILD PROTECTION Dr. Neil Cooper

Dr. Natalie Forbes

Dr. Jennifer MacPherson

DEVELOPMENTAL PAEDIATRICS Dr. Geraldine Farrelly

Dr. Jennifer Fisher

Dr. William Gibbard

Dr. Jean-Francois Lemay

❚ Dr. Kathryn (Kate) MacLellan

Dr. Scott McLeod

Dr. Alison Moore

❚ Dr. Kara Murias

Dr. Kimberley Smyth

Dr. Pamela Veale

HOSPITAL PAEDIATRICS Dr. Christopher Andrews

Dr. Janice Bailey

Dr. Susan Bannister

Dr. Chantelle Barnard

Dr. Jennifer Brenner

Dr. Adeline Brimacombe

Dr. Gary Chow

Dr. Deanna Cook

Dr. Suzette Cooke

Dr. Laura Davies

Dr. Dominique Eustace

Dr. Julie Fisher

Dr. Michael Friesen

Dr. Melissa Gross

Dr. Barbara Grueger

Dr. Hani Hadi

Dr. Sarah Hall

Dr. Michelle Jackman

Dr. Renee Jackson

Dr. Sangeeta Jain

Dr. Quyen Lam

Dr. Lindsay Long

Dr. Catherine Macneil

Dr. Swati Rastogi

Dr. Aaliya Sabir

Dr. Amonpreet Sandhu

Dr. Lindsay Stockdale

Dr. Cristina Stoian

Dr. Siddharth Thakore

❚ Dr. Peter Vetere*

Dr. John Vila

Dr. Gemma Vomiero

Dr. Theresa Wu

NEONATOLOGY Dr. Ayman Abou Mehrem

Dr. Albert Akierman

Dr. Essa Al Awad

Dr. Belal Alshaikh

Dr. Harish Amin

❚ Dr. Amina Benlamri*

Dr. Deborah Clark

Dr. Adel ElSharkawy*

Dr. Carlos Fajardo

Dr. Shabih Hasan

Dr. Jennifer Heath (Neonatal Follow-Up Clinic)

Dr. Leonora Hendson

Dr. Alexandra (Alixe) Howlett

Dr. Majeeda Kamaluddeen

Dr. Thierry Lacaze-Masmonteil

❚ Dr. Lara Leijser

Dr. Abhay Lodha

Dr. Khorshid Mohammad

Dr. Prashanth Murthy

Dr. Yacov (Jack) Rabi

Dr. Nalini Singhal

Dr. Amuchou Soraisham

Dr. Amelie Stritzke

Dr. Sumesh Thomas

Dr. Anne Tierney

Dr. Jennifer Unrau

❚ Dr. Wendy Yee

Dr. Kamran Yusuf

Dr. Hussein Zein

PAEDIATRIC CARDIOLOGY Dr. Robin Clegg

Dr. Franciscus Dicke

Dr. Deborah Fruitman

Dr. Randall Giuffre

Dr. Steven Greenway

Dr. Joyce Harder

Dr. Lindsay Mills

Dr. Kimberley Myers

Dr. David Patton

Dr. Erika Vorhies

PAEDIATRIC CRITICAL CARE Dr. Jaime Blackwood

Dr. Shauna Burkholder

Dr. Paul Doughty

Dr. Tanya Drews

Dr. Mary Fras

Dr. Jonathan Gamble

Dr. Elyahu (Eli) Gilad

Dr. Elaine Gilfoyle

Dr. Jonathan Gilleland

Dr. Shelina Jamal

Dr. Meagan Mahoney

❚ Dr. Jessica Nicoll*

Dr. Simon Parsons

Dr. Barbara (Cathy) Ross

PAEDIATRIC EMERGENCY MEDICINE Dr. Francois Belanger

Dr. Donald Bethune (Supp)

Dr. Michele Bjornson

Dr. Andrea Boone (Supp)

Dr. Mark Bromley (Supp)

Dr. Gavin Burgess

Dr. Ping-Wei Chen (Supp)

Dr. Adam Cheng

Dr. Shirmee Doshi

Dr. Shawn Dowling (Supp)

Dr. Marc Francis (Supp)

Dr. Stephen Freedman

Dr. Roger Galbraith

Dr. Jennifer Graham Wedel

Dr. Jeffrey Grant (Supp)

Dr. Vincent Grant

Dr. Frederick Guilfoyle

Dr. Carey Johnson

Dr. David Johnson

Dr. Kevin Johnson (Supp)

Dr. Kristen Johnson

Dr. Christine Kennedy

Dr. Tanuja Kodeeswaran

Dr. Russell Lam

Dr. Kerri Landry

Dr. David Lendrum (Supp)

Dr. Jacob Les

Dr. Lorraine Mabon

Dr. Joseph MacLellan (Supp)

Dr. Gordon McNeil (Supp)

Dr. Sarah McPherson (Supp)

Dr. Constance McTimoney

Dr. Andre Michalchuk (Supp)

Dr. Patrick Mihalicz

Dr. Kelly Millar

Dr. Shabnam Minoosepehr

Dr. Rhonda Ness (Supp)

Dr. Cheri Nijssen-Jordan

Dr. Mary-Louise O'Byrne

Dr. Adam Oster (Supp)

Dr. Heather Patterson (Supp)

Dr. Michael Pierse

Dr. Naminder Sandhu

Dr. Erik Saude (Supp)

Dr. Michelle Simonelli

Dr. Katharine Smart

Dr. Derrick Smith

Dr. Antonia Stang

❚ Dr. Dana Stys

Dr. Izabela Sztukowski

Dr. Graham Thompson

Dr. Benjamin Thomson

Dr. Margaret (Peggy) Thomson

Dr. Jennifer Thull-Freedman

Dr. Phillip Ukrainetz (Supp)

Dr. Hussein Unwala

Dr. Melanie Willimann

Dr. Ashlea Wilmott (Supp)

Dr. Ian Wishart (Supp)

Dr. Bryan Young (Supp)

PAEDIATRIC EMERGENCY MEDICINE + CHILD PROTECTION Dr. Jennifer D'Mello

PAEDIATRIC ENDOCRINOLOGYDr. Jonathan Dawrant

❚ Dr. Harpreet Gill*

Dr. Josephine Ho

Dr. Carol Huang

Dr. Paola Luca

Dr. Daniele Pacaud

Dr. Rebecca Perry

❚ Dr. Katie Soper*

Dr. Karin Winston

PAEDIATRIC GASTROENTEROLOGYDr. Dana Boctor

Dr. John (Decker) Butzner

Dr. Jennifer DeBruyn

Dr. Gary Galante

Dr. Dominica Gidrewicz

Dr. Helen Machida

Dr. Steven Martin

Dr. Leanna McKenzie

❚ Dr. Richard (Brent) Scott

Dr. Sharron Spicer

Dr. Christopher Waterhouse

Dr. Iwona Wrobel

Dr. Alfred Yeung

PAEDIATRIC HEMATOLOGY/IMMUNOLOGYDr. Doan Le

Dr. Michael Leaker

Dr. Luis Murguia Favela (Immunology only)

Dr. John Steele

Dr. Nicola Wright

PAEDIATRIC INFECTIOUS DISEASES Dr. Rupesh Chawla

Dr. Cora Constantinescu

❚ Dr. Devika Dixit*

Dr. Tajdin Jadavji

Dr. Jim Kellner

Dr. Susan Kuhn

Dr. Mireille LeMay

Dr. Otto Vanderkooi

Dr. Joseph Vayalumkal

PAEDIATRIC MEDICAL GENETICS Dr. Walla Al-Hertani

Dr. Ping-Yee (Billie) Au

Dr. Francois Bernier

Dr. Patrick Ferreira

Dr. Allan (Micheil) Innes

Dr. Aneal Khan

Dr. Julie Lauzon

Dr. Brian Lowry

Dr. Julian Marcadier

Dr. Renee Perrier

Dr. Rebecca Sparkes

Dr. Mary Ann Thomas

PAEDIATRIC NEPHROLOGY Dr. Anke Banks

Dr. Silviu Grisaru

Dr. Lorraine Hamiwka

Dr. Julian Midgley

Dr. Susan Samuel

Dr. Andrew Wade

PAEDIATRIC NEUROLOGY Dr. Juan (JP) Appendino

Dr. Luis Bello-Espinosa

Dr. Jeffrey Buchhalter

Dr. Margaret Clarke

Dr. Colleen Curtis

Dr. Michael Esser

Dr. Heather Graham

Dr. Alice Ho

Dr. C. Adam Kirton

Dr. Jean Mah

❚ Dr. Robyn McPherson*

Dr. Aleksandra Mineyko

Dr. Beverley Prieur

Dr. Jong Rho

Dr. Harvey Sarnat

Dr. Morris Scantlebury

PAEDIATRIC ONCOLOGY AND HSCT Dr. Ronald Anderson

Dr. Gregory Guilcher

Dr. Lucie Lafay-Cousin

Dr. Victor Lewis

Dr. Zoulficar Menhem*

Dr. Arumugavadivel Narendran

Dr. Ravi Shah*

Dr. Gurpreet Singh*

Dr. Douglas Strother

Dr. Tony Truong

PAEDIATRIC PALLIATIVE MEDICINE Dr. Mala Arasu

Dr. Estee Grant

❚ Dr. Amanda Hogg

Dr. Kevin Levere

Dr. Debbie McAllister (Supp)

Dr. Marli Robertson

Dr. Karen-Rose Wilson

PAEDIATRIC RESPIRATORY MEDICINE Dr. Adetayo Adeleye

Dr. Mark Anselmo

Dr. Glenda Bendiak

Dr. Candice Bjornson

Dr. Marielena DiBartolo

Dr. Ashley Humber*

Dr. Karen Kam

Dr. Valerie Kirk

Dr. Erin Kwolek*

Dr. Paul MacEachern (Supp)

Dr. Ian Mitchell

Dr. Mark Montgomery

Dr. Mary Noseworthy

PAEDIATRIC RHEUMATOLOGY Dr. Susanne Benseler

❚ Dr. Muhammed Dhalla*

Dr. Nicole Johnson

Dr. Nadia Luca

Dr. Paivi Miettunen

Dr. Heinrike Schmeling

Dr. Rebeka (Beka) Stevenson

Dr. Marinka Twilt

UNIVERSITY OF CALGARY APPOINTMENT ONLY Dr. Marie-Claire Arrieta

Dr. Karen Barlow

Rev. Phillip Behman

Dr. Karen Benzies

Dr. Graham Boag

Dr. Thomas Bowen

Dr. Brian Brooks

Dr. Marie-Anne Bründler

Dr. Helen Carlson

Dr. Kathleen (Katie) Chaput

Dr. Catherine Chrusch

Dr. Beverly Collisson

Dr. Margaret Ruth Connors

Dr. Dianne Creighton

Dr. Gillian Currie

Dr. Lawrence de Koning

Dr. Gina Dimitropoulos

Ms. Kathleen Douglas-England

Dr. Carolyn Emery

Dr. Rex Farran

Dr. Taryn Fay-McClymont

Dr. Laura Flores-Dinorin (Sarnat)

Dr. Vincent Gabriel

Dr. Clare Gallagher

Dr. Edit Goia

Dr. Walter Hader

Dr. Mark Hamilton

Dr. Laura Kaminsky

Dr. Bonnie Kaplan

Dr. Faisal Khan

Dr. Nicole Letourneau

Dr. Katelyn Lowe

Dr. Shannon MacDonald

Dr. Frank MacMaster

Dr. Carina Majaesic

Dr. Sheila McDonald

Dr. John McLennan

Dr. Carly McMorris

Dr. Tamara Pringsheim

Dr. Jordan Raugust

Dr. Ivan Rebeyka

Dr. Ganesh Shanmugam

Dr. Leonard Smith

Dr. Gesche Tallen

Dr. Lianne Tomfohr

Dr. Samuel Wiebe

Dr. Thomas Christopher Wilkes

Ms. Brenda Wilson

Dr. Kathryn (Kay) Wotton

Dr. James (JR) Wright

Dr. Keith Yeates

Dr. Ephrem Zewdie

UNIVERSITY OF CALGARY REGIONAL Dr. Abdelbasat Aborawi

Dr. Charles Bester

Dr. Sophia Capisonda

Dr. Kerry Chan

Dr. Kathryn Cooke

Dr. Magriet du Plooy

Dr. Talita Ferreira-Van der Watt

Dr. Loretta Fiorillo

Dr. Charlotte Foulston

Dr. Josias Grobler

Dr. Hendrik Hak

Dr. Maya Harilal

Dr. Liesl Heyns - Janse van Rensburg

Dr. John Holland

Dr. Ilona Levin

Dr. Mark Mahood

Dr. Kyle McKenzie

Dr. Carey Molberg

Dr. Ram Nagaruru Venkata

Dr. Vanessa Orrego

Dr. Desmond Shulman

Dr. Gerald Vaz

CHILD & FAMILY HEALTH RESEARCH UNITDr. Deborah Dewey

Dr. Gerald Giesbrecht

Dr. Brent Hagel

Dr. Alberto Nettel-Aguirre

Dr. Maria Santana

Dr. Suzanne Tough

SUPPLEMENTARY/OTHERDr. Abdullah Alabbas

Dr. Lee Burkholder

Dr. Elizabeth Condliffe

Dr. Derek Exner (Supp)

Dr. Nancy Ghazar

Dr. Vithya Gnanakumar

Dr. Daniel Gregson (Supp)

Dr. Jennifer Grossman (Supp)

Dr. Richard Haber (Supp)

Dr. Matthew Hall (Supp)

Dr. Barbara Kellner (Supp)

Dr. Raymond Lewkonia (Supp)

Dr. Ian MacDonald (Supp)

Dr. Leonie Moorhouse Herx

Dr. Jamin Mulvey

Dr. Jennifer Nicol (Supp)

Dr. Tyler Pirlot

Dr. Man-Chiu Poon (Supp)

Dr. Vimal Prajapati (Supp)

Dr. Kathleen (Kathy) Reynolds

Dr. Justyna Sarna

Dr. Adam Spencer (Supp)

Dr. Oksana Suchowersky (Supp)

Dr. Martin Vetter

Dr. Andrew Wong (Supp)

2018 Residents

CURRENT GENERAL PAEDIATRICS RESIDENTS

R1Dr. Abdulaziz Abul

Dr. Lauren Borch (Medical Genetics)

Dr. Amanda Brett

Dr. Alexa Geddes

Dr. Rouzbeh Ghadiry-Tavi

Dr. Dylan Ginter

Dr. Stephanie Hammond (Paediatric Neurology)

Dr. Tasneem Heedar

Dr. Ceilidh-Anne Kinlin

Dr. Susan Knechtel

Dr. Jovana Milenkovic

Dr. Gayathri (Gaya) Narendran

Dr. Meagan Roy

Dr. Erika Russell

Dr. Jennifer Saunders

Dr. Roopa Suppiah

R2Dr. Nikytha (Niky) Antony

Dr. Jazmyn Balfour-Boehm

Dr. Grazyna Burek

Dr. Paige Burgess

Dr. Chantel de Ruiter

Dr. Louise Ing

Dr. Katie Lightfoot

Dr. Kaspar Ng

Dr. Roxanne Pinson

Dr. Anupreet (Anu) Rai

Dr. Lea Restivo

Dr. Anna Schwalfenberg

R3Dr. Brieanne Dergousoff

Dr. Liza (Maria) Espinoza

Dr. Bani Falcon

Dr. Rubeeta Gill

Dr. Jacqueline (Jackie) Harrison

Dr. Stacey Holbrook

Dr. Raisa Kanji

Dr. Brian Lockhart

Dr. Sarah MacEachern

Dr. Jessica Monteiro

Dr. Martin Perlsteyn

R4Dr. Mohammad Al Najjar

Dr. Syeda Abbas

Dr. Krista Clark

Dr. Lundy Day

Dr. Leena Desai

Dr. Donovan Duncan

Dr. Krystyna Ediger

Dr. Simone Kortbeek

Dr. Phillip Quon

Dr. Robert (Bobby) Shyleyko

CURRENT SUBSPECIALTY RESIDENTS AND FELLOWS

HOSPITAL PAEDIATRICSDr. Peter Vetere

KIDSIMDr. Fatema Qasem

Dr. Aida Darwesh

NEONATAL/PERINATAL Dr. Wissam Alburaki

Dr. Dinesh Dharel

Dr. Haytham Eid

Dr. Elhaytham Elsayed

Dr. Anna Louisa Florendo-Chin

Dr. Madhusudan Guin

Dr. Rana Ismail

Dr. Sunil Joghee

Dr. Mary Jim Jose

Dr. Maan Mesmeh

Dr. Smita Roychoudhury

Dr. Khaldoun Sallam

Dr. Zainab Towage

PAEDIATRIC EMERGENCY MEDICINE Dr. Jason Baserman

Dr. Robyn Buna

Dr. Vidushi Khatri

Dr. Karl Phillips

PAEDIATRIC ENDOCRINOLOGYDr. Paul Kahlke

PAEDIATRIC GASTROENTEROLOGY Dr. Jocelyn Jeong

Dr. Jaclyn Strauss

PAEDIATRIC HEMATOLOGY/ONCOLOGY PGY4 Dr. Georgina Martin

PGY4 Dr. Jaspreet Gharial

PGY6 Dr. Nicolas Prud’homme

PGY7 Dr. Melanie Finkbeiner

PGY8 Dr. Lele Aung

BMT Fellow PGY6 Dr. Dania Monagel

BMT Fellow PGY7 Dr. Ashley Szpurko

PAEDIATRIC INFECTIOUS DISEASESDr. Khaled Al Sager

PAEDIATRIC MEDICAL GENETICSPGY1 Dr. Lauren Borch

PGY2 Dr. Eliza Phillips

PGY3 Dr. Xiao-Ru Yang

PGY4 Dr. Caitlin Chang

PGY5 Dr. Melissa MacPherson

PAEDIATRIC NEPHROLOGYDr. Thuraiya Al Sulaimi

Dr. Michelle Ruhl

PAEDIATRIC NEUROLOGY PGY1 Dr. Stephanie Hammond

PGY2 Dr. Kirsten Sjonnesen

PGY3 Dr. Kristine Woodward

PGY5 Dr. Marvin Braun

PGY5 Dr. Momen Almomen

Epilepsy Fellow Dr. Natarie Liu

Stroke Fellow Dr. Mary Dunbar

PAEDIATRIC RESPIRATORY MEDICINEDr. Majid Al Teneiji

Dr. Michael Derynck

Dr. Kirsten Ebbert

Dr. Jody Platt


2018 Faculty

❚ 2018 New Physicians

❚ 2018 Retirees

*Locum


CLINICAL ACTIVITYACH Alberta Children’s Hospital FMC Foothills Medical Centre PLC Peter Lougheed Centre RGH Rockyview General Hospital SHC South Health Campus


ACH Paediatric Inpatient Length of Stay TrendsTotal Discharges per Year by Length of Stay (Days)

2015/2016 610 2,793 1,475 1,013 589 417 248 201 149 102 374 175 124 84 47 42 51 80 37

2016/2017 653 2,689 1,428 978 630 390 270 195 151 126 372 185 111 75 40 29 43 70 40

2017/2018 677 2,778 1,465 862 547 333 246 184 143 121 345 173 95 56 53 33 51 71 28

Days stay is the total number of accumulated inpatient days for patients discharged (including deaths). The day of admission is counted but not the day of discharge. LOS <12 hours included pseudo admissions, and patients in and out the same day or the next calendar day.

Calgary Zone Paediatric DischargesTotal Discharges per Year by Site

ACH Paediatrics* 4,562 4,630 4,533

PLC Paediatrics* 1,170 1,366 1,312

NICU Total (ACH, FMC, PLC, RGH, SHC) 3,292 3,232 3,179

Calgary Zone Total Paediatrics (ACH, PLC) and NICU (total) 9,024 9,228 9,024

*Excluding Neonatology

0

2000

4000

6000

10000

8000

2015/2016 2016/2017 2017/2018

0

20000

40000

60000

80000

2015/2016 2016/2017 2017/2018

Calgary Zone Paediatric Hospital DaysTotal Hospital Days per Year by Site

ACH Paediatrics* 29,613 27,476 26,098

PLC Paediatrics* 2,809 3,143 2,720

NICU Total (ACH, FMC, PLC, RGH, SHC) 44,287 41,784 40,405

Calgary Zone Total Paediatrics (ACH, PLC) and NICU (total) 76,709 72,403 69,223

*Excluding Neonatology

0

500

250

1000

1250

750

< 12 Hr 1 (12+ Hr)

2 3 4 5 6 7 8 9 10-14 15-19 20-24 25-29 30-34 35-39 40-49 50-99 100+

1500

1750

2000

2250

2500

2750

3000


Calgary Zone NICU DischargesTotal Discharges by SiteFiscal Year 2017/2018

* PLC NICU Cases may be included in the PLC Paediatric unit data if patients were discharged from that unit.

0

200

400

600

800

1000

1200

FMC PLC RGH SHCACH

ACH Frequently Encountered Discharge Diagnoses

2017/2018

Diagnosis Discharges LOS ALOS

Acute Bronchiolitis 317 1,313 4.1

Asthma 300 724 2.4

Epilepsy 209 998 4.8

Acute Obstructive Laryngitis (Croup) and Epiglottitis 118 213 1.8

Pneumonia, Organism Unspecified 116 392 3.4

Type 1 Diabetes Mellitus 98 227 2.3

Acute Upper Respiratory Infections of Multiple and Unspecified Sites 98 203 2.1

Abdominal and Pelvic Pain 97 164 1.7

Viral and Other Specified Intestinal Infections 80 270 3.4

Unspecified Acute Lower Respiratory Infection 74 384 5.2

Convulsions, Not Elsewhere Classified 70 159 2.3

Agranulocytosis 47 244 5.2

These are some of the most frequent discharge diagnoses, excluding mental health and surgical admissions.

ACH Inpatient Activity by Most Responsible Physician Section

2017/2018

Medical Sections Discharges Total Days ALOS

Cardiology 96 582 6.1

Endocrinology 112 311 2.8

Gastroenterology 148 823 5.6

Infectious Diseases 2 7 3.5

Intensivist 288 3,065 10.6

Medical Genetics 5 19 3.8

Neonatology 251 3,853 15.4

Nephrology 157 1,069 6.8

Neurology 245 815 3.3

Oncology/Hematology 478 4,263 8.9

Paediatric Medicine 2,954 14,600 4.9

Respirology 47 543 11.6

Rheumatology 1 1 –

Total – Medical 4,784 29,951 6.4

Annual Unit Paediatric Occupancy

ACH PLC FMC RGH SHC

Surgical Mental Short Fiscal Year Unit 1 Unit 2 Unit 3 Unit 4 Health NICU PICU Stay Total Paeds NICU NICU NICU NICU

2015/2016 94% 93% 97% 99% 115% 86% 71% 66% 93% 75% 88% 93% 83% 86%

2016/2017 80% 91% 98% 94% 110% 85% 65% 57% 89% 71% 94% 90% 80% 79%

2017/2018 87% 89% 94% 92% 109% 87% 65% 50% 88% 69% 84% 89% 77% 83%

PLC Paediatric Unit Admissions by Admission Type

Paediatric Direct Direct Admits to Inpatient Outpatient Admit Other– Other–No Paed Unit Transfer Transfer Thru PLC Jaundice Jaundice Fiscal Year (Age <18Y) from ACH from ACH ED Dx Dx

2017/2018 1,286 17 545 154 440 130

2018 Annual Report 5756 Department of Paediatrics

NICU Activity by Site

2017/2018

NICU Indicators ACH FMC PLC* RGH SHC Total

Discharges 291 1,155 590 722 421 3,179

Total Days Stay 6,138 12,709 8,002 8,696 4,860 40,405

Average Length of Stay (ALOS) 21.1 11.0 13.6 12.0 11.5 12.7

Intracity Transfer 33 509 34 54 32 662

Total Days in NICU Unit 4,206 11,972 7,492 8,143 4,575 36,388

Average Case Weight (ARIW) 6.63 3.06 2.64 2.43 2.41 3.08

Unique Patients – – – – – 2,450

Average Neonatal Length of Stay per Patient (Days) – – – – – 16.5

* PLC NICU Cases may be included in the PLC Paediatric unit data if patients were discharged from that unit. Unique Patients is the number of babies with a stay in NICU (based on uli) discharged in the fiscal year. Average neonatal stay for these patients includes all days stay in a Calgary hospital prior to discharge by March 31. Average Case Weight for all years is based on 2015 values.


ACH PICU Activity

Fiscal Year 2017/2018

PICU Cases 867

Total Admissions/Transfers Into PICU* 887

Admissions to PICU* 494

Transfers Into PICU from Units* 255

Transfers Into PICU from ADOP/PACU* 138

Discharge from or Death in PICU 208

Transfers Out of PICU to Units* 673

PICU Unit LOS 3,397

Hospital LOS – PICU Cases 10,585

Extracorporeal Life Support (ECLS) Cases* 4

*Fiscal year based on hospital admission date, others based on hospital discharge date. Patients may have more than 1 admission, transfer into PICU, and transfers out of PICU on a hospital stay. Extracorporeal life support cases are collected if the following CIHI criteria are met, effective April 2012: -performance in an operating/intervention room (e.g. endoscopy room or cardiac catheterization room), or; -performance in the presence of an anesthetist (i.e. anesthetic record on the chart), or; -performance using the following approaches: open, endoscopic, or percutaneous transluminal/transarterial.

Emergency Department Paediatric Mental Health Visits

2017/2018

Mental Mental # Mental % Mental Health Admit Health Mental Mental Total Paed Health Health from ED to Transfer to Health ED Health ED Site ED Visits Visits ED Visits Same Site Another Site Discharge LWBS

ACH 77,164 3,290 4.3 709 205 2,308 68

SHC 14,265 638 4.5 92 50 477 19

Total Other Sites (FMC, PLC, RGH) 11,455 698 6.1 147 60 463 28

Paediatric refers to patients < 18 years of age. Mental Health defined by diagnoses codes used by Addictions and Mental Health on ED visits.

% Change 2017/2018 v Total Research Revenue* 2012/2013

Department/Faculty 2012/2013 2017/2018

Paediatrics $6.9 M $12.3 M +78%

Total Cumming School of Medicine $168.0 M $198.3 M +18%

% Change 2017/2018 v Total Research Revenue Per Research Equivalent (RE) 2012/2013



Total Cumming School of Medicine $0.86 M $0.73 M -15%

% Change 2017/2018 v Total CIHR Research Revenue 2012/2013




% Change 2017/2018 v Total Clinical Research Revenue 2012/2013




Publications/Full-Time Equivalent (FTE)

% Change/ Department/Faculty 2012 2017/2018 5 years

Paediatrics 2.1 4.2 +100%

Cumming School of Medicine 2.7 3.9 +44%

Citations/FTE

% Change/ Department/Faculty 2012 2017/2018 5 years

Paediatrics 58 132 +127%

Cumming School of Medicine 146 237 +28%

50+ Citations in 1st 5 Years

% Change Department/Faculty 2012 2017/2018 /5 years

Paediatrics 11 32 +191%

Cumming School of Medicine 215 397 +85%

2018 Annual Report 5958 Department of Paediatrics

Resusc CTAS Level 1

Emergent CTAS Level 2

Urgent CTAS Level 3

Semi-Urgent CTAS Level 4

Non-Urgent CTAS Level 5

0

8000

16000

24000

32000

ACH Emergency Room Visits and AdmissionsTotal Patients by CTAS ScoreFiscal Year 2017/2018

Total Emergency Room Visits by CTAS Score Admissions from ACH Emergency Room by CTAS Score

Paediatric Emergency Department (ED) VisitsTotal ED Visits by SiteFiscal Year 2017/2018

ACH (77,274) SHC (14,500)

84.3%15.7%

RESEARCH METRICS

*Total Research Revenue includes various large-scale grants, includ-ing four Project Grants (Fall 2017 and Spring 2018) from the Canadian Institutes of Health Research (CIHR), and two grants from Genome Canada’s 2017 Large-Scale Applied Research Project Competition.

For further details on these large-scale grants, as well as a list of 2018 publications from the Department of Paediatrics, visit our website: www.ucalgary.ca/paed/about






OUR RECOGNITION

CARE Award Educator

DR. LORRAINE HAMIWKA

As a paediatric nephrologist and

member of the Department of

Paediatrics for the past 16 years, Dr. Lorraine

Hamiwka established our first paediatric

nephrology subspecialty training

program over a decade ago and has

been the Program Director ever since.

During this time, she has worked tirelessly to make the program one of the best and most sought after subspe-cialty training programs in the country, in addition to being a popular choice for international medical graduates. A recent Royal College accreditation of the program was completed without a single deficiency being noted! She is highly supportive of trainees, meeting with them regularly, and also conducts “boot camps” to assist trainees from other countries in adjusting to life in Canada. This year, her leadership resulted in a seamless transition to Competence by Design (CBD) for paediatric nephrology. As this was the first paediatric training program to implement CBD, her exper-tise will be invaluable as other training programs make the transition over the next several years. She has been instru-mental in the establishment of a new fellowship program in paediatric vas-culitis, a collaboration with the Section of Paediatric Rheumatology. The first Canadian trainee started in July 2018, with an additional European trainee to start soon. Furthermore, Hamiwka is active in undergraduate medical educa-tion as the evaluation coordinator for the renal component of the Women’s and Child Health course. Overall, Hamiwka’s effort and dedication has resulted in an enviable legacy for the Section of Paediatric Nephrology at the Alberta Children’s Hospital and Cumming School of Medicine.

CARE Award Clinician

DR. MICHAEL ESSER

Dr. Michael Esser has been

a paediatric neurologist at the Alberta Children’s Hospital for seven

years and an exemplary clinician

throughout this time.

Over the past several years he has pioneered a revolution in the clinical care of critically ill newborns and children at the Alberta Children’s Hospital with the development of the NeuroCritical Care (NCC) initiative. In addition to neurol-ogy, this multidisciplinary team includes neonatology, paediatric intensive care, neurosurgery, neuroradiology, and allied health. The team provides consultation and ongoing care to some of the most critically ill children in the hospital who are suffering from neurological conditions that impact the brain. This model is highly patient and family-centered, from the time of arrival in the emergency depart-ment or the paediatric intensive care unit through short and long-term stays and outpatient follow up. His work has resulted in improved, prioritized neurolog-ical care with consistent communication between team members and families. In addition to having been the key developer of this initiative and Director of the NCC program, Esser carries out a large part of the clinical load and does this with insight, patience and compassion. This attitude extends not only to families but also to his colleagues, whom he treats with utmost respect. The NCC program immediately impacted clinical care with multiple research initiatives, protocol development, quality assurance efforts, and advanced infrastructure, including a new state-of-the-art BioCORE facility. The NCC program is an important step forward and will continue to improve patient care for many years to come.


CARE Award Researcher

DR. GREG GUILCHER

Paediatric oncologist Dr. Greg Guilcher

has been a member of the Department of

Paediatrics for the past 12 years.

Also an associate member of ACHRI, he is a dedicated researcher, clinician and collaborator. In addition to being a site investigator for numerous phase I, II and III clinical trials, his research inter-ests include acute and late toxicities of bone marrow transplantation (BMT), as well as the study of novel low-tox-icity approaches to BMT for paediatric non-malignant diseases. An area of specific focus is hematopoetic stem cell transplantation (HSCT) for sickle cell disease. He is the founding Vice-Chair of the Sickle Cell Transplant Alliance for Research (STAR), an international non-profit organization dedicated to research on blood and marrow transplantation as a curative therapy for sickle cell disease. As the only Canadian team participating in STAR, Guilcher’s team has placed the Alberta Children’s Hospital on the map as an internationally recognized leader in sickle cell research. To date, there have been 20 curative BMT procedures for patients with sickle cell disease at the Alberta Children’s Hospital. Guilcher is also interested in the study of family BMT decision-making, neuropsychological outcomes, health economics questions, and paediatric donor safety related to BMT, with numerous publications on these topics. He is currently involved in research in Africa, and a career goal is to further expand BMT access for sickle cell disease to low- and middle-income countries. In addition to these impressive accom-plishments, Guilcher is also the Program Director for the hematology-oncology subspecialty residency program within the Department of Paediatrics, helping to ensure that his passion for research will be passed on to future generations.

Dr. Brent Scott has retired after 36 years with the Department of Paediatrics.

An esteemed gastroenterologist and a nationally prominent clinician-scientist in intestinal physiology, Scott was also Head of the Department of Paediatrics for 10 years, leading the department through a period of tremendous change during the move from the former Alberta Children’s Hospital site to our current hospital. After completing two terms as Department Head, he moved on to become the Director of the Alberta Children’s Hospital Research Institute (ACHRI). He held this post for the past 10 years, with the institute experiencing significant growth during his tenure.

Dr. Monique Wright has retired after 29 years with the Department of Paediatrics.

Wright completed her residency at the Alberta Children’s Hospital and had a diverse practice based as a community paediatrician. In addition to providing outstanding care in the community setting during this time, she provided newborn care at the Foothills Medical Centre for many years, was a long-stand-ing consultant at the Asthma Clinic at the Alberta Children’s Hospital, and provided assessments for Paediatrics for Kids in Care (P-KIC). She also served on the General Paediatrics Residency Training Committee for many years, and taught countless residents and medical students in her community office.

Neonatologist Dr. Wendy Yee has retired after 24 years with the Department of Paediatrics.

During this time, Yee worked primarily within the neonatal intensive care unit (NICU) at the Rockyview General Hospital, where she was the Site Leader for Neonatology for many years. She was an excellent clinician and teacher within the hospital over the course of her career, providing support to numer-ous community paediatricians, as well. She is admired for her calm, steadfast approach, which she maintained even in the setting of medical emergencies.

2018 Community Paediatrician

of the Year

DR. LORI KARDAL

Dr. Lori Kardal is one of the

unsung heroes within the Section

of Community Paediatrics.

A native Calgarian, she completed medical school at the University of British Columbia, followed by an intern-ship in Saskatchewan. She completed her residency at the Alberta Children’s Hospital in 1994 and has been a member of the Department of Paediatrics for 24 years. During this time, she has worked in a group practice in Calgary, providing competent and compassionate care for a wide spectrum of paediatric patients, ranging from premature newborns to adolescents with developmental delays. Kardal is highly respected by her col-leagues who appreciate her many years of leadership, her sunny disposition, and her willingness to stop whatever she is doing to provide counsel on challeng-ing cases. She routinely seeks out events in continuing medical education and attends local and international confer-ences to keep her knowledge current. She will happily share her wisdom with colleagues and is a great role model for work-life balance. Most impor-tantly, her patients reap the benefits of her dedication and thoughtfulness. Unquestionably, paediatric care in Calgary has benefitted greatly from Kardal’s ongoing contributions.

2018 Administrator of the Year

JENNIFER THURSTON

Jennifer Thurston has been with the

Section of Paediatric Cardiology for the

past 13 years.

During that time, she has witnessed many changes in the Cardiology Clinic at the Alberta Children’s Hospital, and her role has evolved accordingly. What has remained unchanged over this time is her healthy and positive attitude. Although she has a quiet demeanour, Thurston has never shied away from a challenge. Over the past year she has single-handedly supported up to ten cardiologists! No matter what she is tasked with, she always maintains her resourcefulness and confidence while figuring out how to make it happen. She is an invaluable part of the team in pae-diatric cardiology, and her colleagues are so pleased that she has been recog-nized with this well-deserved award.


CARE Award Advocate And Leader

DR. VICTORIA (VICKI) KENDRICK

Dr. Victoria (Vicki) Kendrick is a community

paediatrician in Calgary and has

been a member of the Department of

Paediatrics for 21 years.

Soon after joining the department, Kendrick began working in the Alberta Children’s Hospital Vascular Birthmark clinic. For the past two years, she has been the lead of the clinic and has become one of North America’s leading experts in vascular birth marks. She attends international meetings and conferences, and liaises with specialists and paediatricians across the country, helping them to establish similar clinics. She has advocated for patients at the Alberta Children’s Hospital to receive novel therapies in the rapidly changing field of vascular anomalies, treatments that have been life-changing for the patients and have decreased the burden to the health-care system. Her work includes advocating for and coordinating out-of-province or out-of-country care when necessary. She also sets up patient to patient connections so that families who are struggling with rare and often disfiguring conditions have someone to reach out to in difficult times. Kendrick has led ongoing educational and quality improvement initiatives for the clinic, such as organizing various speakers and developing guidelines for optimal man-agement of vascular anomalies. She has also collaborated with other subspe-cialty clinics to establish a coordinated approach in the development of patient care pathways. Kendrick provides strong leadership for more junior members of the team and always makes herself available to discuss difficult cases. Her leadership and advocacy efforts have resulted in the best possible care for thousands of patients throughout Alberta.

2018 Distinguished Career Award

DR. BRENT SCOTT


DR. MONIQUE WRIGHT


DR. WENDY YEE


2018 INNOVATION AWARDSTo be announced in March 2019

DR. KATHY TOBLER RESEARCH AWARDSThe Paediatric Residency Program Scholarly Oversight Committee established the Kathy Tobler Scholarly Excellence Awards this year, providing $500 for four R1 or R2 paediatric residents who apply and are awarded on merit.

This year's successful applicants were:

Dr. Ceilidh Kinlin (General Paediatrics)

"The association between opioid administration and ultrasound visual-ization of the appendix: a retrospective cohort study of children present-ing to the Emergency Department with sus-pected appendicitis"

Dr. Paige Burgess (General Paediatrics)

"Will provincial rates of hospital admissions for RSV bronchiolitis amongst infants born 29 to 32 completed weeks increase following changes to the Alberta RSV Prevention Program (ARSVPP) disallowing palivizumab administration to this entire cohort?"

Dr. Nikytha Antony (General Paediatrics)

"Among Canadian paediat-ric respirologists, is there variability on weaning supplemental oxygen in premature patients with BPD aged 4-12 months?"

Dr. Sarah MacEachern (General Paediatrics)

"Physical Activity Participation for Children with Disabilities"

2018 UNDERGRADUATE MEDICAL EDUCATION (UME) TEACHING AWARDS

JUNIOR PAEDIATRICS RESIDENTDr. Jessica Monteiro (General Paediatrics)

SENIOR PAEDIATRICS RESIDENTDr. Stacy Yeh (General Paediatrics)

FACULTY – COMMUNITY PAEDIATRICSDr. Kyle McKenzie (Red Deer)

FACULTY – HOSPITAL PAEDIATRICSDr. Renee Jackson (Alberta Children’s Hospital)

2018 POSTGRADUATE MEDICAL EDUCATION (PGME) TEACHING AWARDS DR. HUSAM ZAKI (SAM) DARWISH CLINICAL TEACHER OF THE YEAR AWARDIn Recognition of Excellence in Clinical Teaching (Presented by the Alberta Children’s Hospital Paediatric Residents)

SUBSPECIALTY PAEDIATRICSDr. Amelie Stritzke (Neonatology)

Dr. Erika Vorhies (Paediatric Cardiology)

COMMUNITY PAEDIATRICSDr. Keith Jorgenson (Peter Lougheed Centre)

HOSPITAL PAEDIATRICSDr. Renee Jackson (Alberta Children’s Hospital)

CLINICAL TEACHER OF THE YEAR Awarded to Subspecialty Fellows in Recognition of Outstanding and Dedicated Teaching to the Paediatric Residents at Alberta Children’s Hospital

Dr. Paul Kahlke (Paediatric Endocrinology)

2018 DR. GEORGE PRIEUR PAEDIATRICS SCHOLARSHIP AWARDDr. Simone Kortbeek (General Paediatrics)

2018 RESIDENT RESEARCH DAY AWARDDr. Phillip Quon (General Paediatrics)

DR. SUSAN KING PAEDIATRIC ABSTRACT AWARDDr. Raisa Kanji (General Paediatrics)

DEPARTMENT OF PAEDIATRICS 2018 GRADUATE SCHOLARSHIPKelsey Chomistek Master of Science in Medical Science (Supervisor: Dr. Heinrike Schmeling, Paediatric Rheumatology)

UNIVERSITY OF CALGARY’S 2018 CANADA GRADUATE SCHOLARSHIP (CGS) MASTER’S AWARD Asha Hollis Master of Science in Neuroscience (Supervisor: Dr. Adam Kirton, Paediatric Neurology)

UNIVERSITY OF CALGARY 2018 PRESIDENT'S AWARDGabrielle Wagner Bachelor of Science in Biological Sciences with Distinction (Supervisor: Dr. Graham Thompson, Paediatric Emergency Medicine)


ACKNOWLEDGEMENTSThe Department of Paediatrics gratefully acknowledges and thanks the following individuals and groups for their con-tributions to this report.

Project ManagerDr. Jennifer MacPherson, Deputy Head Professional Affairs, Department of Paediatrics

Editorial Development and ManagementAlison Shepherd, Communications Coordinator, Department of Paediatrics

Design and ProductionFrank Design Strategy Inc., Calgary, AB

PrintingEmerson Clarke Printing Corporation, Calgary, AB

PhotographyColin Way Photography Inc., Calgary, AB

Collation of Publications and DataChantelle Cini, Physician Affairs Coordinator, Department of Paediatrics

Claire Trojan, Administrative Assistant, Department of Paediatrics

Data Collection, Preparation, and ReportingDiane Moser, Health Information Analyst, Alberta Health Services

Alberta Health Services Child Health Annual Report 2017/2018

Special thanks to the Alberta Children’s Hospital Foundation, Alberta Children’s Hospital Research Institute, Department of Paediatrics Administrative staff, Section Chiefs, Department members and Administrative Assistants for their contributions.

We would also like to express our appreciation to our patients and their families featured in this report.

Stay tuned for 2019

Dedicated care for children with medical complexity

Strengthening career development through mentorship

Big data for child health research

Evaluating treatment options with clinical trials

Awards

transitioning department patients from · collected as part of the research study and transferred...

Documents