UBC Medicine

A few years ago, the waiting room at Kelowna General Hospital’s emergency deparment was routinely packed, but not necessarily because there were too many patients and too few doctors and nurses. Sometimes, bottlenecks resulted in the physicians waiting for patients, even as the patients were waiting to see the physicians. Something had to change.  Fortunately, they were able to get coaching from their colleagues throughout BC, through a collaborative called “Evidence to Excellence.” Led by Julian Marsden, a Clinical Professor in the Department of Emergency Medicine, E2E is an “online community of practice,” in which physicians, nurses and front-line administrators share information through teleconferences, webinars and occasionally in person. With guidance from E2E, Kelowna General’s emergency department started “streaming,” whereby patients who don’t need to be put on a bed are tended to in chairs. The result: the waiting room is now usually empty, and patient satisfaction has increased from 78 percent to 92 percent. E2E is similarly credited with helping Chilliwack General Hospital improve its screening procedures for septic patients, lowering the sepsis mortality rate from 44 percent to 7 percent. Read more about E2E in the latest issue of UBC Medicine magazine.

Hang Time is an iPhone app that calculates the precise amount of time an iPhone spends falling to the ground. Another app, called Hello Cow, emits a variety of mooing sounds. Haircaster predicts what kind of hair day it will be. OK, maybe those aren’t the best examples of how technology helps society. But here’s one: BC Guidelines. Despite its decidedly uncatchy name, it could prove a lot more useful, at least to health care providers. Developed by the eHealth Strategy Office in the UBC Faculty of Medicine, BC Guidelines provides advice about 30 different conditions, including ankle injury, cataracts, mammography and rheumatoid arthritis. The idea is that physicians, nurses and therapists will have access to detailed information for diagnosis and treatment without even leaving the examining room. (What, you thought they could memorize all that stuff they learned in school?) One thousand copies of the program were downloaded with the first two weeks of its release. Read more about the app in the fall 2010 issue of UBC Medicine magazine.

When a patient is harmed or comes close to being harmed in a health care setting, the first impulse is to blame the worker caring for the patient at the time. That person often winds up losing their job — a justifiable outcome to a public that is increasingly demanding accountability. But Sam Sheps is convinced it’s neither a solution, nor fair. The Professor in the School of Population and Public Health has been studying patient safety for years, and is pushing health care organizations to be more introspective about such incidents — examining the worker’s actions in the context of the entire organization, and the pressures it puts upon its workers. He promotes an idea called “organizational resilience,” in which managers ask tough questions — at the highest levels — about why things go awry. “Human error, in any context, is not an explanation,” Dr. Sheps says. “It requires an explanation.” He and Research Associate Karen Cardiff have received a four-year grant from the Canadian Health Services Research Foundation and the Canadian Patient Safety Institute to explore whether training in organizational resilience leads managers to be more expansive in how they react to adverse events. Read more about their research in the fall 2010 issue of UBC Medicine magazine.

Multiple sclerosis patients in Canada have been galvanized over the past few months by news reports about an Italian doctor who claims to have hit upon a cause — and treatment — for their disease. Paolo Zamboni’s theory is called chronic cerebrospinal venous insufficiency, or CCSVI, and posits that the large veins that drain blood from the brain and spinal cord have been narrowed in some MS patients, causing congestion of blood in the brain and triggering inflammation, possibly from accumulution of iron deposits. He has developed what he calls “liberation treatment,” in which the veins are dilated through angioplasty or a stent, and says the treatment has worked wonders for some MS patients (including his wife). But it’s so new that there isn’t reliable data to prove the validity of the theory or the treatment. Some desperate MS patients have gone ahead and been scanned for the condition and even traveled to other countries where physicians have been willing to perform the treatment. The MS Society of Canada and the National MS Society in the U.S. have now awarded a series of research grants to determine if CCSVI can be definitively proven as a cause of MS. A team of researchers at UBC, the Vancouver Coastal Health Research Institute and the University of Saskatchewan  is one of those grant recipients, and will recruit 100 MS patients and 100 non-patients in both provinces. Among those resesearch subjects will be pairs of identical twins in which one sibling has MS and the other does not, to determine if CCSVI — if it is indeed real — has a genetic link. Learn more about CCSVI and UBC’s efforts to explore this new theory through the Faculty of Medicine’s website.

The prognosis for someone with chronic liver disease is grim. The only real cure is a transplant, and more than a third of those waiting for a donated liver die before one becomes available. Compounding that dire situation is the disease’s association with alcohol consumption — a stigma felt acutely by members of the First Nations. But a team of UBC faculty members have made it their mission to show that liver disease among BC’s aboriginal people isn’t always self-inflicted. Primary Biliary Cirrhosis, a rare autoimmune disease in the general population, is the leading cause of liver transplantation among aboriginal people. Eric Yoshida, Professor and Head of the Division of Gastroenterology, and Laura Arbour, an Associate Professor of Medical Genetics, first uncovered the pattern a decade ago, and have been trying to spread the word among physicians in the province. They hope their efforts will enable for early diagnosis, so the condition can be treated as as early as possible — and its victims will be spared the burden of blaming themselves. Their story is featured in the spring issue of UBC Medicine magazine.

OK, so maybe there’s some truth to the “ivory tower” image of universities, even at UBC. But here’s a notable exception: ”Aboriginal Public Health in Canada: Ethics, Policy and Practice,” a graduate-level course in the School of Population and Public Health. Taught by Associate Professor Patricia Spittal (pictured on right), the course brings in speakers, including Chief Wayne Christian of the Splats’in First Nation (pictured on left), to offer their first-hand accounts of the health challenges facing aboriginal people.  They talk about the legacy of residential schools, the impact of diabetes and the H1N1 virus on aboriginal communities, and the role of traditional medicines. “Speaking to people who have actually lived through these expereicnes is so much more informative than reading it from a book,” one student says. (Not that there’s anything wrong with books!) Read more about the course in the latest issue of UBC Medicine magazine.

Rare disease actually isn’t so rare. It’s generally defined as a genetic malady affecting one out of every 2,000 or more people. But that is still too small a percentage to attract the attention of the traditional research establishment — unless there is some incentive. Two young faculty members in the Department of Medical Genetics are seeking to create that incentive. Millan Patel (left) and Neal Boerkoel (right) are promoting a new model for helping patients – often children – who suffer from rare conditions. They envision a ”research champion” who facilitates the transition of a research problem from one scientist to another by providing the relevant clinical information, tissue samples, cell lines and reagents. That way, researchers aren’t asked to go on a time-consuming fishing expedition; instead, they are presented with a focused question with a decent chance of finding an answer. Dr. Boerkoel calls it a “gift box with a ribbon on it.” To promote their model, they have teamed up with some patient families to create the Rare Disease Foundation. Their goal is to demonstrate the model’s efficacy with a  few of the 6,000 rare disorders, so that the model catches on beyond BC. Read more about their project in UBC Medicine magazine.

It’s now pretty clear that misfolded proteins are the cause of “mad cow disease.” Neil Cashman, a Professor in the Division of Neurology, believes those toxic molecules also play a role in other neurodegenerative diseases, such as Alzheimer’s, Parkinson’s and ALS. But for all the credibility that Dr. Cashman brings to the game (one of his titles is “Canada Research Chair in Neurodegeneration and Protein Misfolding Diseases”), finding the funds to pursue such a hypothesis can be daunting, even for him. Fortunately, he found a benefactor: William Lambert, who works for Birch Hill Equity in Toronto, and serves as a Director on Dr. Cashman’s biotech company, Amorfix Life Sciences. Lambert wanted to give to a project that couldn’t attract traditional funding because it was too risky, and Dr. Cashman’s hypothesis fit the bill. The $1 million in donations paid off — Dr. Cashman was able to generate enough data to get a grant from the Canadian Institutes of Health Research. Read more about this philanthropic success story in the latest issue of UBC Medicine magazine.

For the past year or so, the term “medical isotopes” has been surfacing in news reports with increasing regularity, and for good reason: the supply of those decaying atoms, which are the necessary ingredients for cardiac and bone scans, has been choked off. Canada’s medical facilities have long depended on a single nuclear reactor in Ontario to get the radioactive material needed to produce those isotopes. But that reactor, now 52 years old, has been shut down for a year, and even if it opens again this spring, it’s nearing the end of its useful life. What to do? Two members of the Faculty of Medicine think they have an answer. Francois Benard, a Professor of Radiology, and Thomas Ruth, an Adjunct Professor in the Department of Medicine, believe that cyclotrons, which are smaller, more numerous, safer and easier to operate than nuclear reactors, can be adapted to the task of making the necessary type of isotope (called technetium-99m). The federal government has given the two men $1.3 million and two years to see if cyclotrons are a feasible alternative. The method hasn’t caught on yet because the reactor-based method did the job so well.  But just as the threat of peak oil and global warming has spurred an intensified search for alternative energy sources, the increasing obsolescence of an Ontario nuclear reactor is forcing us to sharpen our pencils, roll up our sleeves, and tinker. Their research, and the crisis underlying it, is one of several topics covered in the latest issue of UBC Medicine magazine.

After years of hard work, Dr. Andrei Krassioukov has finally earned admission to the Athletes Village at the 2010 Vancouver Paralympic Games. Krassioukov isn’t a competitor — he’s an internationally recognized expert in spinal cord injury (SCI) and leader of the only research team to be granted access to the Vancouver Athletes Village during the Games. Krassioukov, a Clinical Associate Professor in the Department of Medicine, and members of his team will investigate the controversial practice of “boosting.” Practiced by some individuals with spinal cord injury (SCI), boosting involves intentionally raising blood pressure to stimulate the body’s energy and endurance. Paralympic athletes use boosting to win — it can improve performance by up to 15 per cent. Stressing techniques to stimulate parts of the body below the level of the spinal cord injury, and to produce a spike in blood pressure, can range from wearing pressure stockings, to compressing the testicles by sitting on a handful of ball bearings, or blocking a urinary catheter to distend the bladder. Besides creating an unfair competitive advantage, boosting is a dangerous practice. The sudden surge in blood pressure typically seen during boosting is known as autonomic dysreflexia and can lead to stroke, heart attack or death. But the International Paralympics Committee (IPC) 1994 ban on boosting has been difficult to enforce. Krassioukov’s research has led him to advocate for revising the athlete classification system for the Paralympic Games, thus removing the incentive to engage in boosting. Read more about his work here.