DEPARTMENT OF MEDICINE E-Mail Newsletter April 2009 Volume 2 Issue 4 Message from the Physician-in-Chief Dear Colleagues, It has been a very busy and productive year in the Department of Medicine. We have accomplished almost ALL of our short term goals in our strategic plan (see below) Recently we successfully implemented the Web CV for all faculty members in the Department. Now we can push a button and produce our annual reports, promotion dossiers and CIHR common CV. The Web CV will also be a major benefit in measuring our overall teaching and research efforts. Here are some of the highlights of our accomplishments. Faculty  Create a Recruitment/Retention Committee  Develop a 3-year recruitment plan  Recruit 1-2 new division heads Host2 Annual events to celebrate achievements  Ensure mentorship for new faculty Research  Launch Centre for Patient Safety/Quality with U of T  Promote researchers through newsletter Establish database grants/publications through WebCV  Participate in U of T Internal Grant Review  Include 2-3 Translational Sciences topics into Grand Rounds Clinical □ Implement routine benchmarks of quality  Improve hand hygiene rates by 20%  Conduct needs assessment for P&G support  Establish early discharge clinic for GIM  Institute M&M rounds in inpatient services Education  Create a database of current ambulatory teaching  Develop quality/patient safety curriculum  Incorporate 4 P&G topics into Grand Rounds  Host educational scholarship symposium Funding and Infrastructure Perform quarterly variance analysis Revise terms of reference for funding committees  Create 3-year recruitment budget Assess Medical Oncology Practice Plan arrangement  Implement WebCV I am also pleased to report that the budgets for our education and research efforts have been confirmed for next year. We also have a recruitment budget to support our ongoing efforts to build our faculty. Finally, I wish everyone a wonderful summer. Hope you have a good break from the busy pace of work life. All the best, Wendy Department of Medicine E-mail Newsletter Pg. 2 Spotlight- Dr. Eugenia Piliotis Eugenia Piliotis TAAAC – Toronto Addis Ababa Academic Collaboration Written by Dr. Eugenia Piliotis Over the last year an exciting new educational collaboration has developed between the Department of Medicine of the University of Toronto and Addis Ababa University (AAU) in Ethiopia with a vision to build capacity and sustainability in subspecialty medical training and clinical research at AAU. This collaboration is an extension of a similar highly successful partnership between the departments of Psychiatry of UofT and AAU. Ethiopia has a population of approximately 80 million people with 1800 physicians including 100 internists. AAU has a long standing well developed 3 year specialty training program in general internal medicine, however subspecialist training requires physicians to leave the country. This is of course very expensive for individuals and a university in a developing country to sponsor, but also unfortunately most physicians who leave the country for additional training never return to Ethiopia. The philosophy of TAAAC is to build subspecialty training programs housed in AAU so internists have local access to training that results in Ethiopian credentials. The development of these programs is led by the few Ethiopian medical subspecialists that do exist, based on Ethiopian needs, with the help of UofT staff in curriculum development and most importantly hands on teaching. Our project is modeled on the successful Psychiatry partnership which began in 2004 and has now seen 4 classes graduated. The number of psychiatrist in the country has increased from only 10 to 36, with most of the new graduates being hired back as AAU faculty further developing the training program. In Internal Medicine each subspecialty program will have a UofT lead faculty to help the AAU Subspecialists develop curriculum as well as to recruit volunteer educators to travel to Addis Ababa for one month blocks of teaching. Within each subspecialty we plan to send 1-2 staff as well as one senior resident with each trip, 3 trips per year with a 2 year curriculum. Starting in January 2010 we will be launching training programs in Gastroenterology (leads Louis Liu and Jordan Feld – UHN), Endocrinology (lead Julia Lowe – Sunnybrook) and Hematology (lead Gena Piliotis – Sunnybrook). Hopefully once our project has been running successfully for a few years we will be able to add further subspecialty training programs based on Ethiopian needs and UofT capacity. The UofT Department of Medicine will provide travel costs and AAU will provide accommodations. This is an exciting opportunity for UofT to be leaders in Global Education as well as to join with AAU in collaborative research in education, epidemiology as well as clinical research. This project also provides individual UofT staff with the unique opportunity to be involved hands on in the building of higher education in a developing world. Any one interested in more information or of course to volunteer! please contact the individual leads below. [email protected] [email protected] [email protected] [email protected] Department of Medicine E-mail Newsletter Pg. 3 Dr. Teshale Seboxa (L) – Head of Infectious Diseases, Dr. Piliotis and Dr. Abate Bane (R) Head Department of Internal Medicine and Gastroenterology Dr. Eugenia Piliotis is a Clinician Educator and Assistant Professor in the Division of Medical Oncology/Haematology, Department of Medicine at the Sunnybrook Health Sciences Centre and the University of Toronto; She has been on staff at Sunnybrook since 2004. Dr. Piliotis is the Education Co-ordinator for the Sunnybrook Haematology Programme and is also actively involved with the Uof T Core Internal Medicine training program. She is also involved in clinical research in malignant haematology with a particular interest in Cutaneous Lymphoma and is the Program Director of the University of Toronto Haematology Training Program. In the News Published in the April 5th 2009 online edition of the Toronto Star “At the intersection of art and reality, a life-altering project is born. A best-selling author encounters the doctor who inspired one of her characters. Altruism ensues” LESLIE SCRIVENER, Staff reporter, Toronto Star What happens when fiction meets reality? When the writer is Camilla Gibb and the subject is an Ethiopian doctor who inspired the character with "butter-soft dark skin and bright teeth" in her bestseller, the outcome might be the education of a generation of medical students Here is the fiction: "He was different, this man, this Dr. Aziz. He made me feel different: stirred, compelled, vaguely anxious." With this, Gibb, in her novel Sweetness in the Belly, introduces the erudite and idealistic Dr. Aziz Abdulnasser. Aziz falls in love with Lilly, a white Muslim woman who lives in the gorgeous decrepitude of Harar, the ancient walled city in Ethiopia. As their love deepens, they are caught in the 1974 overthrow of Emperor Haile Selassie. Aziz disappears and Lilly flees to London, where she becomes a nurse, lives with Ethiopian refugees, and pines for the handsome doctor. Here is the reality: Gibb, who has roots in London and Toronto, did live in Harar in 1994 and 1995, researching her PhD dissertation on religious practices in Islam. Troubled by an intestinal disorder, she paid one birr (about 14 cents) to be treated at the local hospital. While there, Gibb, then 25, met a tall, "über-educated," English-speaking young doctor named Abdulaziz Sherif. They share books – Jane Austen, Dostoevsky – meet in berchas, Saturday gatherings where Ethiopians chew khat (a plant used as a stimulant) and discuss the issues of the day. "There was a level of comprehension, a whole new level of conversation," Gibb says. "I could be so much more myself." Department of Medicine E-mail Newsletter Pg. 4 Gibb and Sherif have not publicly discussed their literary and real-life connection, and it's taken an ambitious project to get them to break that silence. Citing a link between literature and medicine, and Ethiopia and Canada, they want to talk about an academic exchange between the University of Toronto and the University of Addis Ababa spurred in part by Gibb's book. It seemed natural to expand a collaboration that had been so effective in psychiatry. Under that program, in which University of Toronto academics volunteered to teach in Ethiopia for a month three times a year, the number of psychiatrists grew from nine to 34. The new proposal would broaden the program to 10 disciplines, including medicine, nursing, pharmacy and library sciences. "That would likely not have happened without (Gibb's) book," says Dr. Eugenia Piliotis, haematology program director at Sunnybrook Health Sciences Centre. With 1,800 doctors and perhaps 200 specialists for a population of 80 million, Ethiopia has the highest brain drain of doctors in Africa. According to a report by Dr. Clare Pain, a Mount Sinai psychiatrist, some 80 per cent of Ethiopian doctors trained abroad don't return. It was Gibb, now 41, who suggested that Pain – who had launched the successful U of T supplemental training program for residents in psychiatry at Addis Ababa University in 2003 – meet Sherif and "start a conversation." Sherif himself underscores the need for an academic exchange. Though he is one of Ethiopia's two haematologists (Toronto has about 70), he has had no formal training in the field. "Perhaps my biggest exposure is the time I've spent here." Which brings us back to the crossroads of fiction and reality. The two recently met for the first time in 15 years in Toronto, where Sherif is a visiting observer in haematology at Sunnybrook. Gibb is now a celebrated author. Sweetness in the Belly has been translated into eight languages, won the Trillium Book Award and was a finalist for the Giller Prize. Sherif is an assistant professor at Addis Ababa University and will return to Ethiopia this month. His deeply rooted reserve remains. "Some may not even know I am in the room," he says. What happens, we wondered, when someone unaccustomed to public attention finds himself not only a character but also a love interest in a novel? "I saw myself in part of it, yes, but I am kind of shy and low profile and not as outspoken as that guy," Sherif says. "But compassion, and so on, I think I am kind of like that." Now 38, he has close-cropped hair, a moustache and the smooth skin and white teeth of his fictional counterpart. Physical resemblance aside, "This is a fiction," he says. "Somebody should talk about the character in the book, not me." Gibb steps in: "People make the assumption that I'm Lilly. They completely conflate the characters to the extent that I have been at lunch with people who ask if I'm a nurse in London... It's fiction that takes its inspiration from a real place and real people." One of the topics that Gibb and Sherif have never discussed is the fact that the novel includes a sex scene, nor has Sherif discussed his similarity to the Sweetness character with his wife. He doesn't even know if she has read the book. As for being asked if the friends ever had a more intimate relationship, the question simply wouldn't come up in Ethiopia, says Sherif. "Our community in Harar is very closed and everybody knows everybody," he explains. "The book has not circulated in the country, so I didn't have to make explanations." Department of Medicine E-mail Newsletter Pg. 5 Selected Publications March/April 2009 Clinical Pharmacology & Toxicology David Juurlink: Letters / Editorials: Juurlink DN, Tu JV, Mamdani MM. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel (109-0015). (Letter) CMAJ. 2009 Jun 9;180(12):1229 Publications: Gomes T, Juulink DN, Lipscombe LL, Mamdani MM. Clinical and Demographic Characteristics of Patients Receiving Different Oral Hypoglycemic Agents. Pharmacoepidemiology and Drug Safety. Pharmacoepidemiol Drug Saf. 2009 Apr 28 [Epub ahead of print]. - Juurlink DN, Gomes T, Ko DT, Szmitko PE, Austin PC, Tu JV, Henry DA, Kopp A, Mamdani MM. A population-based study of the drug interaction between proton pump inhibitors and clopidogrel. CMAJ. 2009 Mar 31;180(7):713-8. [Epub 2009 Jan 28]. Infectious Diseases Nick Daneman: Infect Control Hosp Epidemiol. 2009 May 4; Validation of a Modified Version of the National Nosocomial Infections Surveillance System Risk Index for Health Services Research. Nick Daneman, Andrew E Simor, Donald A Redelmeier Andy Simor: Williams VR, Callery S, Vearncombe M, Simor AE. The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus. Am J Infect Control 2009; 37:106-110. - Loeb M, Neupane B, Walter SD, Carusone SC, Lewis D, Kreuger P, Simor AE, Nicolle L, Marrie TJ. Environmental risk factors for community-acquired pneumonia hospitalization in older adults. J Am Geriatr Soc 2009; 5:1036-40. Medical Oncology/Haematology Craig Earle: Snyder C.F., Frick K.D., Peairs K.S., Kantsiper M.E., Herbert R.J., Blackford A.L., Wolff A.C., Earle C.C. Senior Responsible Author. Comparing Care for Breast Cancer Survivors to Non-Cancer Controls: A FiveYear Longitudinal Study. J Gen Intern Med 2009 Apr;24(4):469-74. Nephrology Sheldon Tobe: Burgess E, Muirhead N, de Cotret PR, Chiu A, Pichette V, Tobe S: Supramaximal Dose of Candesartan in Proteinuric Renal Disease. J Am Soc Nephrol 2009. - Campbell NR, Khan NA, Hill MD, Tremblay G, Lebel M, Kaczorowski J, McAlister FA, Lewanczuk RZ, Tobe S: 2009 Canadian Hypertension Education Program recommendations: the scientific summary--an annual update. Can J Cardiol 2009;25:271-277. - Campbell NR, Leiter LA, Larochelle P, Tobe S, Chockalingam A, Ward R, Morris D, Tsuyuki R: Hypertension in diabetes: a call to action. Can J Cardiol 2009;25:299-302. - Khan NA, Hemmelgarn B, Herman RJ, Bell CM, Mahon JL, Leiter LA, Rabkin SW, Hill MD, Padwal R, Touyz RM, Larochelle P, Feldman RD, Schiffrin EL, Campbell NR, Moe G, Prasad R, Arnold MO, Campbell TS, Milot A, Stone JA, Jones C, Ogilvie RI, Hamet P, Fodor G, Carruthers G, Burns KD, Ruzicka M, Dechamplain J, Pylypchuk G, Petrella R, Boulanger JM, Trudeau L, Hegele RA, Woo V, McFarlane P, Vallee M, Howlett J, Bacon SL, Lindsay P, Gilbert RE, Lewanczuk RZ, Tobe S: The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 2--therapy. Can J Cardiol 2009;25:287-298. Department of Medicine E-mail Newsletter Pg. 6 - Myers MG, Valdivieso M, Kiss A, Tobe SW: Comparison of two automated sphygmomanometers for use in the office setting. Blood Press Monit 2009;14:45-47. - Padwal RS, Hemmelgarn BR, Khan NA, Grover S, McKay DW, Wilson T, Penner B, Burgess E, McAlister FA, Bolli P, Hill MD, Mahon J, Myers MG, Abbott C, Schiffrin EL, Honos G, Mann K, Tremblay G, Milot A, Cloutier L, Chockalingam A, Rabkin SW, Dawes M, Touyz RM, Bell C, Burns KD, Ruzicka M, Campbell NR, Vallee M, Prasad R, Lebel M, Tobe SW: The 2009 Canadian Hypertension Education Program recommendations for the management of hypertension: Part 1--blood pressure measurement, diagnosis and assessment of risk. Can J Cardiol 2009;25:279-286. - Prasad GV, Ruzicka M, Burns KD, Tobe SW, Lebel M: Hypertension in dialysis and kidney transplant patients. Can J Cardiol 2009;25:309-314. - Scholl UI, Choi M, Liu T, Ramaekers VT, Hausler MG, Grimmer J, Tobe SW, Farhi A, Nelson-Williams C, Lifton RP: Seizures, sensorineural deafness, ataxia, mental retardation, and electrolyte imbalance (SeSAME syndrome) caused by mutations in KCNJ10. Proc Natl Acad Sci U S A 2009. - Tobe SW, Lewanczuk R: Resistant hypertension. Can J Cardiol 2009;25:315-317. - Tobe SW, Wentworth J, Ironstand L, Hartman S, Hoppe J, Whiting J, Kennedy J, McAllister C, Kiss A, Perkins N, Vincent L, Pylypchuk G, Lewanczuk RZ: DreamTel; Diabetes risk evaluation and management tele-monitoring study. BMC Endocr Disord 2009;9:13. Grants Received March/April 2009 Clinical Pharmacology & Toxicology David Juurlink: Canadian Institutes of Health Research, Emerging Team Grant: Health Services and Policy Research. Canadian Drug Safety and Effectiveness Research Network (CDSERN). $1,379,400 over 5 years (20092014). Principal Investigator. Gastroenterology Jill Tinmouth: Canadian Cancer Society Research Institute Operating Grant on “Quality in colonoscopy: Validation of quality indicators. Principal Investigator. $165,863 Honours and Awards Wendy Levinson: Society of General internal Medicine highest award, the Robert J. Glaser Award. The award recognizes outstanding contributions to research, education, or both in generalism in medicine. Infectious Diseases Nick Daneman: Canadian Institutes Health Research, Clinician Scientist Phase I Award Neurology Sandra Black : U of T Faculty Award for Excellence in Mentorship. This award is “specifically designed to recognize a faculty member who has served as an outstanding mentor helping new faculty to develop their professional careers and, in some cases, to juggle the competing challenges of their personal lives”. Department of Medicine E-mail Newsletter Pg. 7 - MD-PhD student, Graeme Schwindt, was awarded a Vanier Canada Graduate Scholarship by CIHR for his thesis project entitled “Functional and structural brain imaging in Alzheimer’s Disease: Towards a biomarker of treatment response and decline”. The Vanier provides $45,000 per year plus $5,000 in research expenses for up to 3 years. Graeme also has the distinction of being ranked first of 673 in his category (clinical research) in all of Canada! - Co-Author on poster presented by one of Dr. Black’s previous PhD student Pearl Behl who is now a third year medical student at U of T. Pearl was awarded the prize for best clinical research poster in the Comprehensive Research Experience for Medical Students (CREMS) Research Day for her work entitled “Cholinesterase Inhibitor Treatment Slows Decline in Multiple Cognitive Domains in Alzheimer’s Disease: A 1-Year, Prospective, Cohort Study”. Pearl completed her PhD in IMS in 2006 entitled “Response to Cholinergic Agents in AD: A Clinical-Neuroimaging Study” under Dr. Black’s supervision at Sunnybrook Health Sciences Centre. Rehabilitation Medicine David Berbrayer : University of Toronto Division of Physiatry Achievement Award 2008 "for exceptional service towards the development and growth of the Division of Physiatry at the University of Toronto" Department News Activity Report The deadline for submission of the 2008-2009 Activity Reports is June 26, 2009; please use the WebCV to generate your report. Dr. Levinson will be meeting with members of staff throughout the summer to review individual reports. Please contact Claudette Chambers x4592 or [email protected] to schedule your appointment, it is expected that reviews will be completed by August 31, 2009 U of T Internal Grant Review Service: The service is directed specifically for junior faculty members at the Assistant and Lecturer ranks. It is a non-threatening review of your grant designed to help improve your odds of getting funded. All you need to do is have your grant prepared 30 days prior to the submission date to allow time for the review. As you prepare your grant, talk to your University Division Director (ie at least 6 weeks before the grant deadline). They will help you choose 2 reviewers. For more information go to the DOM web site. http://www.deptmedicine.utoronto.ca/Research/internalgrant.htm You can also call Conrad Liles (416 340 3183) [email protected], Professor and Vice Chair of Medicine who has created this program. Or contact Sheldon Tobe at Sunnybrook x 6901, [email protected]. Spring Fling: The department held its Spring Fling” on April 28th in the Main Ballroom at the Vaughan Estates. The event celebrated long standing full-time members in the department who have been at Sunnybrook for 20 years or more. Pictures from the night’s event are below Drs. Berbrayer and Levinson Drs. Saibil and Cohen Drs Levinson and Fettes Department of Medicine E-mail Newsletter Pg. 8 Drs. Webster and Sivjee Drs. Geerts and Sivjee Drs. Gilbert and Joyner Drs. Pritchard and Imrie Drs. Cohen and Levinson Drs. Levinson and Shear Drs. Rachlis and Simor Drs. Silverberg, Fettes and Levinson Department of Medicine Sunnybrook Health Sciences Centre 2075 Bayview Ave Suite D4-74 Toronto Ontario M4N 3M5 Phone: 416-480-4592 Fax: 416-480-6191 Email: [email protected] Fully affiliated with the University of Toronto For questions, comments and submissions, please contact Denise Campbell [email protected] or 416-480-6100 x2007