McGill University
and
McGill University Health Centre
Division of General Internal Medicine
The overarching mission of the McGill University Division of General Internal Medicine is to continue to grow as an academic leader in clinical care, medical education and research. Specific areas of growth currently include quality improvement, peri-operative medicine, vascular health and medical obstetrics. Excellence and leadership in clinical care, research and education are integral building blocks for accomplishing this mission.
I. Highlights
Achievements
A. A successful External Review of the McGill GIM Division
The external reviewers, Drs Anita Palepu, University of British Columbia, and Michel Normand, Université Laval, gave the following comments:
Strengths
• The leadership of the chief of division is strong and the vision is clear.
Major clinical innovations are actively being developed: complex care centre,
vascular medicine, peri-operative medicine, obstetrical medicine, quality
improvement.
• Members are dedicated to the care of their patients. They provide the
backbone of clinical services in their hospitals.
• Medical education and teaching are a priority for members and forms a large
part of their core identity and these activities are highly valued. They provide
the backbone of medical education to the medical students and core residents
in internal medicine.
• Research and academic realization – all research activities have been
extremely successful and the division has demonstrated its ability to attract
new and promising clinician scientists.
• Emulating environment that promotes and supports personal academic growth.
B. Several QI Initiatives in GIM continue to lead QI at McGill
i) McGill Quality Improvement Centre (MQuic).
Drs Dev Jayaraman, Laurence Green, Todd Lee (new recruit) and Blair Schwartz (GIM Fellow) have developed the MQuic. Dr Schwartz will be recruited at the JGH upon completion of his Master’s degree at Hopkins in QI.
ii) Quality Improvement
Dr Todd Lee spearheaded an antibiotic audit process coupled with an educational tool. This data collection will form part of his Master’s degree work at Harvard.
Dr Blair Schwartz collected data on Foley catheter use and misuse on the medical wards. This data collection will form part of his Master’s degree work at Hopkins.
C. Pre-Op Medicine
Pre-Op Medical Director, Dr David Hornstein, set up the MGH pre-op clinic, which opened in May 2011.
Dr Jeff Segal will be recruited to St. Mary’s Hospital after completing his formation complémentaire in pre-op medicine at Maisonneuve Rosemont.
D. Vascular Health Unit
A vascular medicine clinic was opened at the MGH. Led by Dr Stella Daskalopoulou, it is a fruitful collaboration between Vascular Surgery and our Division.
Dr Khue Ly was recruited by the Division to join the Vascular Health Unit upon completion of her vascular medicine fellowship at Université Laval in July 2012.
Canadian Foundation for Innovation (CFI) funds were obtained to purchase a server and a 3D ultrasound machine for vascular studies.
With these funds, Christine Bieri, an IT professional, was hired to construct a vascular database that will be the first OWORD/OASIS outpatient database at the MUHC. This clinical database will also be used as a research database.
Dr Leora Birnbaum joined the Division and will play a predominant clinical role in the Vascular Health Unit.
E. Medical Obstetrics
At both the RVH and St. Mary`s, the clinic is physically hosted in the obstetrics area in order to work with nurses with obstetrical experience as well as (at the RVH) provide face to face contact with the obstetrical colleagues. The major initiatives to date that have been successfully implemented include: pre-evaluation of all patients by a nurse with the taking of vital signs and use of home BP sheets.
F. Complex Care Centre / Challenges
Division members are still developing the complex care centre. The development has been stalled due to lack of resources. We need a nurse coordinator / manager to be able to start the project.
However, the out-patient GIM clinics at the MGH and RVH continue to provide excellent care and teaching to medical residents and students.
Promotions, Appointments and Nominations
Dr Sam Benaroya was appointed Interim Dean, Faculty of Medicine from Sept to Dec 2011.
Dr Joyce Pickering was appointed the Executive Associate Physician-in-Chief and Director of Operations of the MUHC Department of Medicine on 1 July 2011.
Dr Kaberi Dasgupta was promoted to an Associate Professor of Medicine with tenure in June 2011.
Dr Lucie Opatrny was appointed Chair of the MUHC Medical Dental Pharmacy Evaluation Committee.
Dr Lucie Opatrny was elected to the FMSQ board. She is the Division representative at the FMSQ and ASMIQ.
Dr Lucie Opatrny completed her MSc in Health Care Management at Harvard University in May 2011.
Dr Beth Cummings received her MSc in Health Professions Education at Maastrict University, at the AMEE Conference in Vienna in August 2011. Dr Cummings graduated Cum Laude.
Past Year’s Activities
1) Teaching Activities
General Internal Medicine Fellowship Program (R4-R5)
In July 2011, 4 new Fellows joined the Program for a total of 16 for the 2011-2012 academic year.
Videoconferences of weekly Tuesday Academic Sessions are teleconferenced to the three Montreal hospitals (JGH, MGH &RVH) and to the outlying regions Amos, Valleyfield, Hull and Rouyn Noranda.
The 1st workshop on “How to Find a Job in the Community” was held on November 8th, 2011 with presentations from recent GIM graduates, Drs. Amos Hercz and Jennifer Nguyen who have found work in the community as well as advice from representatives from the FMRQ regarding PREMs.
The new GIM website ( http://www.medicine.mcgill.ca/gimresident/)
designed by a recent graduate Dr. Jean-François Ethier, was officially launched in July 2011.
Dr. Karen Okrainec was selected for the Travel Award for the European School of Internal Medicine conference in Brighton, England which was held in September 2011.
GIM Fellows abstract presentations:
Dr Michelle Edwards’s abstract entitled Prepartum BMI, intrapartum insulin resistance, and higher intrapartum systolic blood pressure predict post partum dyslipidemia in women with gestational diabetes was selected for oral presentation at the Research Session at the CSIM on October 13th, 2011.
Dr Karen Okrainec won the CSIM Ted Giles Clinical Vignettes Prize 2011 for her abstract, POEMS syndrome: finding rhyme and reason in a complex, debilitating and uncommon diagnosis. It was selected for oral presentation at the Ted Giles Clinical Vignettes Prize session at the CSIM Annual Scientific Meeting October 12-15, 2011 in Halifax, NS.
2) Research
Canadian Foundation for Innovations (CFI)
A joint CFI funding between McGill and the CR CHUM on metabolic syndrome (co-PI Dr Louise Pilote) was used to buy equipment for the vascular health unit. Drs Daskalopoulou and Dasgupta will use the equipment for their research.
Dr Suzanne Morin is a Chercheur-boursier clinician, Ranked 1st for her project: Osteoporosis and hip fractures: treatment strategies.
Collaborative Projects (repeated under #4 Partnerships)
Headed by Drs Kaberi Dasgupta and Stella Daskalopoulou, a successful operating grant application to the CIHR, Step monitoring to improve ARTERial health (SMARTER) was ranked 5 / 51, in the top 9.8% within the peer review committee.
Co-applicants: Dr L. Pilote, Dr S. Kahn, Dr S. Bacon, Prof. L. Joseph and Dr Ellen Rosenberg.
International Activities and Research Collaboration
E. Schiffrin
Dr. Schiffrin is Vice-President (2010-2012) and President Elect, International Society of Hypertension (2011-12).
Associate Editor of Hypertension, journal of the American Heart Association, renewed for an additional 5 years until 2017, where he handles 20% of manuscripts, CME and editorial commentaries.
Editor of two books, one on molecular methods in hypertension and the other a textbook of hypertension with colleagues in Glasgow, UK.
Co-chair, writing group of the American heart Association Position Paper on “Arterial Stiffness: Recommendations for Assessment and Use.”
International consortium with the Baker Research Institute in Melbourne, Australia, studying oxidative stress in type 1 diabetes
International collaboration with the vascular group with Hôpital Européen Georges Pompidou in Paris and the Université de Paris VI
Président de la Table régionale de chefs de départements de médecine spécialisée de l'Île de Montréal à l'Agence de santé et services sociaux
Membre du Conseil d'administration de l'Agence de santé et services sociaux
Repeatedly chairs international meetings (American Heart Association Council for High Blood Pressure Research, American Heart Association National Meeting, International Hypertension Society Meeting, etc.)
S. Kahn
International Guideline leadership: Deputy Editor, Prevention of Venous Thromboembolism in Non-Surgical Patients, Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians (ACCP) Evidence-Based Clinical Practice Guidelines (9th Edition)
International research collaborations (my role: Chair of Clinical Outcomes Committee, Steering Committee member, Data coordinating centre member): 2008-2013 (ongoing trial)
V. Tagalakis
Writing physician clinical guidelines for the British Medical Journal (BMJ) on thromboprophylaxis and on the treatment of superficial vein thrombophlebitis.
a) Tagalakis V. Superficial thrombophlebitis (revised). BMJ Point-of-Care 2011, available at https://online.epocrates.com/u/2911335/Superficial+thrombophlebitis
b) Routhier N, Tagalakis V. VTE prophylaxis (revised). BMJ Point-of-Care 2011, available at: https://online.epocrates.com/u/29111087/VTE+prophylaxis
National Activities / Collaboration
E. Schiffrin
Member of Board of Hypertension Canada
Chair of the Endocrine and member of the Vascular Protection committees of the Canadian Hypertension Education Program
Repeatedly chairs national meetings such as the Québec Hypertension Society
L. Pilote
The GENESIS network held its 7th national meeting in Montreal. The PRAXY study has enrolled 1020 patients across 23 Canadian sites.
S. Kahn
National research meeting organized: VECTOR Pan-Canadian Collaborative Research Conference on Venous Thromboembolism clinical and mechanistic research. Montreal, May 6, 2011. (120 attendees; international speakers and attendees)
V. Tagalakis
Writing book chapter for the Royal College of Physicians and Surgeons of Canada Research Primer book
Tagalakis V. Principles of research and protocol writing (book chapter) Harvey BJ, ES Lang and JR Frank. The research guide: a primer for residents, other health care trainees, and practitioners. Ottawa: Royal College of Physicians and Surgeons of Canada Research Guide 2011.
Noteworthy Publications
K. Dasgupta
Manjoo P, Joseph L, Dasgupta K. Abdominal Adiposity and Daily Step Counts as Determinants of Glycemic Control in a Cohort of Patients with Type 2 Diabetes Mellitus. [Original research article] Nutrition & Diabetes, a Nature Publishing Group journal. First published January 16 2012; 2(25): doi:10.1038/nutd.2011.22
Jarvandi S, Bader A, Gougeon R, Dasgupta K. Differences in Food Intake among Obese and Non-obese Women and Men with Type 2 Diabetes. [Original research article] Journal of the American College of Nutrition 2011;30(4): 225-232. PubMed PMID: 21917702
Lega I, Ross NA, Zhong L, Dasgupta K. Gestational diabetes history may signal deprivation in women with type 2 diabetes [Original research article]. J Womens Health (Larchmt) 2011 20(4):625-9. PubMed PMID: 21342014
S. Daskalopoulou
Doonan, RJ, Scheffler P, Yu A, Egiziano G, Mutter A, Bacon S, Carli F, Daskalopoulos ME, Daskalopoulou SS. Altered Arterial Stiffness and Subendocardial Viability Ratio in Young Healthy Light Smokers After Acute Exercise. PLoS One. 2011;6(10):e26151.
Gomez Sandoval YH, Braganza MV, Daskalopoulou SS. Statin Discontinuation in High-Risk Patients: a systematic review of the evidence. Curr Pharm Des. 2011 Nov;17(33):3669-89.
K. Flegel
MacDonald NE, Flegel K, Hébert PC, Stanbrook MB. Better management of chronic pain care for all. CMAJ 2011;183:1815.
Flegel K, Macdonald NE, Coutts J, Hébert PC, Stanbrook MB. Food in Canada: Eat at your own risk. CMAJ 2011;183:E1274.
Flegel K, MacDonald N, Hébert PC.Binge drinking: all too prevalent and hazardous. CMAJ 2011;183:411.
J. Hoffer
Zhang M, Robitaille L, Eintracht S, Hoffer LJ. Vitamin C provision improves mood in acutely hospitalized patients. Nutrition 27: 530-533, 2011 (doi:10.1016/j.nut.2010.05.016)
Hoffer, LJ How much protein do parenteral amino acid mixtures provide? Am J Clin Nutr 94:1396-1398, 2011
S. Kahn
Guanella R, Ducruet T, Johri M, Miron MJ, Roussin A, Desmarais S, Joyal F, Kassis J, Solymoss S, Ginsberg JS, Lamping DL, Shrier I, Kahn SR. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation. J Thromb Haemost 2011;12:2397-405.
Kahn SR, Shrier I, Shapiro S, Houweling AH, Hirsch AM, Reid RD, Kearon C, Rabhi K, Rodger MA, Kovacs MJ, Anderson DR, Wells PS. Six-month exercise training program to treat post-thrombotic syndrome: a randomized controlled two-centre trial. CMAJ 2011;183:37-44.
S. Morin
Leslie WD, Metge CJ, Azimaee M, Lix LM, Finlayson GS, Morin SN, Caetano P. Direct costs of fractures in Canada and trends 1996-2006: a population-based cost-of-illness analysis. J Bone Miner Res 2011;10:2419-29.
Morin S, Lix LM, Azimaee M, Metge C, Majumdar SR, Leslie WD. Institutionalization following incident non-traumatic fractures in community-dwelling mean and women. Osteoporos Int 2011 [Epub ahead of print Oct 19]
Leslie WD, Morin S. Fracture burden in relation to low bone mineral density and FRAX(®) probability. J Clin Densitom 2011;3:279-85.
L. Pilote
Eisenberg M, Afilalo A, Lawler PR, Abrahamowicz M, Richard H, Pilote L. Cancer Risk Related to Low-Dose Ionizing Radiation from Medical Imaging in Patients Following Acute Myocardial Infarction. CMAJ 2011 Mar 8;183(4):430-6.
Jackevicius CA, Tom A, Essebag V, Eisenberg MJ, Rahme E, Tu JV, Humphries K, Behlouli H, Richard H, Pilote L. Population-Level Incidence and Risk Factors for Pulmonary Toxicity Associated With Amiodarone. American Journal of Cardiology 2011 Sep 1;108(5):705-10.
E. Schiffrin
Simeone SMC, Li MW, Paradis P, Schiffrin EL. Vascular gene expression in mice overexpressing human endothelin-1 targeted to the endothelium. Physiol Genomics. 2011;43:148-160.
Barhoumi T, Kasal DAB, Li MW, Shbat L, Laurant P, Fritsch Neves M, Paradis P, Schiffrin EL. T regulatory lymphocytes prevent angiotensin II-induced hypertension and vascular injury. Hypertension. 2011; 57: 469-476.
Marchesi C, Essalmani R, Lemarié C, Leibovitz E, Ebrahimian T, Paradis P, Seidah NG, Schiffrin EL, Prat A. Inactivation of endothelial proprotein convertase 5/6 decreases collagen deposition in the cardiovascular system: Role of fibroblast autophagy. J Mol Med. 2011;89:1103-1111.
L. Snell
Snell L. The Resident as Teacher: It’s More than Just About Student Learning. Sept 2011, J Grad Med Educ, Sept 2011; 3(3):440-442.
Jamal M, Rousseau M, Hanna W, Doi S, Meterrisian S, Snell L. Effect of the ACGME Work-Hour Restrictions on Surgical Residents and Faculty: A Systematic Review. Academic Medicine Jan 2011; 88(1):34-42.
Steinert Y & Snell L. From Curriculum Design to Implementation: Educational Innovation and Scholarship. In Creating and Redesigning Curricula – a CanMEDS Guide for Clinical Education. Eds Sherbino J & Frank J. RCPSC, Ottawa, 2011. (Book Chapter)