Division Reports - Faculty of Health Sciences - McMaster University

Reports: Division Directors
Cardiology
Dr. Stuart Connolly74
Clinical Immunology and Allergy
Dr. Judah Denburg
Clinical Pharmacology and Therapeutics
Dr. Anne Holbrook
Critical Care
Dr. Andy Freitag
Dermatology
Dr. Judy Wismer
Emergency Medicine
Dr. Margaret Ackerman
Endocrinology and Metabolism
Dr. Hertzel Gerstein
Gastroenterology
Dr. Paul Moayyedi
76
78
80
82
84
86
88
90
92
94
96
98
100
102
104
106
General Internal Medicine
Dr. Akbar Panju
Geriatric Medicine
Dr. Sharon Marr
Hematology and
Thromboembolism
Dr. Mark Crowther
Infectious Diseases
Dr. Mark Loeb
Nephrology
Dr. Alistair Ingram
Neurology
Dr. John Turnbull
Physical Medicine
and Rehabilitation
Dr. Shanker Nesathurai
Respirology
Dr. Gerard Cox
Rheumatology
Dr. Alfred Cividino

74
REPORTS: DIVISION DIRECTORS
Educational Activities
Program Director: Dr. Alison Montgomery
The Cardiology Residency Program has expanded
to a total of 12 trainees, 4 of whom are Gulf
State Trainees. Presently, all educational activities
occur at the Hamilton General Hospital, with
the exception of the two months of Pediatric
Cardiology and Adult Congenital at McMaster.
Plans are underway to expand learning opportunities
at HGH and Juravinski to accommodate the
‘Access to the Best Care’ centralization of cardiac
services and shift in the General Internal Medicine
Clinical Teaching Unit. Dr. Sherryn Rambihar,
PGY5, received the Gold Medal 2010 for oral presentation
at the annual Department of Medicine
Research Day.
Daily teaching rounds are provided with extensive
curriculum development over the past
three years, as well as multiple evaluative tools
(OSCE’s, written and oral examinations), which
have resulted in continued success for our
trainees in their subsequent Fellowships and
RCPSC exams.
Research Program
Dr. Stuart J. Connolly
MD, FRCPC
Division Director
Cardiology
Divisional members play leading roles as Principal/Lead Investigators,
working through national and international networks.
The major research programs in the Division are
in clinical trials, epidemiology and laboratory-
based studies on the major factors affecting our
cardiovascular health. These are on the following
themes in which divisional members play leading
roles as Principal/Lead Investigators, working
through national and international networks:
acute coronary syndromes and myocardial infarction,
cardiac arrhythmias (sudden death, implantable
defibrillators, rhythm and anti-thrombotic
management in atrial fibrillation), heart failure
(in-hospital and community management), prevention
of cardiovascular disease (primary and
secondary prevention, risk factors), and quality of
care initiatives. While most of these studies are
carried out under the umbrella of the Population
Health Research Institute (e.g. INTERHEART,
OASIS 5 & 6, ONTARGET, POISE, HOPE-TOO,
DREAM and EpiDREAM, ACTIVE, ORIGIN, PURE,
GIFT, WAVE, FAMILY, BENEFIT), individual members
also collaborate and lead other studies with
national and international colleagues in addressing
major questions in cardiology and cardiovascular
diseases (e.g. CHARM, DINAMIT, ASSERT,
I-PACE, RAFT, COURAGE, FATE, ASTRONOMER,
AIM HIGH).
All of these studies will have a large impact on
the understanding and treatment of almost all
aspects of cardiac and cardiovascular risk factors
and diseases. Funding for these studies comes
from numerous sources, including national grant-
ing agencies and industry partners. Members
have been successful in obtaining major grants
from the CIHR, Heart and Stroke Foundation and
other granting authorities. A major strength of
the Division continues to be the mentorship,
help and support provided to junior colleagues
with research programs to help them become
established. Reflecting broad involvement by
members and the large areas of research, the
Division continues to maintain a prolific publication
productivity with over 100 publications per
year. Findings from the research have influenced
the prevention and treatment of cardiovascular
diseases globally.
Major Achievements
The Cardiology Division continues a very active
role in cardiovascular research. It is associated
closely with the Population Health Research
Institute (PHRI) and many members of the
Division of Cardiology are active scientists within
this institute.
Future Directions
Major new directions for the Division of
Cardiology will be to align our services through
‘Access to the Best Care’, with changes occurring
in all four hospitals in the City. Cardiology
consolidation has been in the planning stages
for many years and will be realized as ABC is
implemented. A major initiative is the development
of a peri-operative high-risk management
unit at the Juravinski Hospital to provide clinical
care and research opportunities related to the
management of patients at high risk for cardiovascular
adverse events while undergoing noncardiac
surgery. Another major initiative will be
consolidation of the non-invasive cardiac diagnostic
units at Hamilton Health Sciences under
single leadership and hospital management.
The plan is to upgrade these services, especially
echocardiography, to continue to provide a high
level of clinical care.
Andrew Ha, Sherryn Rambihar, Craig Ainsworth and Raymond Chan review an interesting case with Dr. Girish Nair in the electrophysiology lab.

76
REPORTS: DIVISION DIRECTORS
Educational Activities
Dr. Judah A. Denburg
MD, FRCPC
Division Director
Clinical
Immunology and Allergy
The Clinical Immunology and Allergy training program is the
only integrated Adult/Pediatric program in the country and
received full approval in the most recent Royal College onsite review.
The Clinical Immunology and Allergy training
program is the only integrated Adult/Pediatric
program in the country and received full approval
in the most recent Royal College onsite review.
Dr. Michael Cyr continues as Training Program
Director. There is also an RCPSC-approved
combined subspecialty training program in
Rheumatology/Clinical Immunology and Allergy
that has previously trained one candidate.
There are five fellows, from both Pediatrics and
Internal Medicine, currently in full-time training. In
addition to medical residents, four clinical clerks
train in Clinical Immunology and Allergy along
with medical students doing electives. Graduating
trainees have proceeded to academic and clinical
careers in Clinical Immunology and Allergy in
Canada and internationally. In addition, a substantial
number of postdoctoral PhD and MD research
fellows, as well as visiting scientists, regularly
join our division.
Undergraduate teaching is well supported
by our divisional faculty. Our weekly Allergy
and Immunology Rounds, with internationally
renowned invited speakers on occasion, are
a major success, and receive support through
unrestricted educational grants. Other seminars,
journal clubs and teaching sessions are a regular
feature including the weekly academic half-days.
Although she was with us only a short time, the
Division wishes Dr. Petra Arck all the best as she
returns to her home in Germany.
Research Programs
Principle research themes are Inflammation
and Immunity as they relate to the respiratory
tract (allergic rhinitis, nasal polyposis, asthma),
but with interests also in other organ systems.
Specific themes for which the group has international
renown include autoimmune diseases,
mechanisms of allergic inflammation and
immune regulation, respiratory inflammation,
asthma, and reproductive immunology. Peerreviewed
and private sector funding for investigation
into allergic airways inflammation, food
allergy, immunoregulation, stress and immunity,
and new biologics in pre-clinical and clinical
models continues to grow. Thus, there exist many
research opportunities for students, postdoctoral
fellows and others pursuing continuing medical
education for an investigative career. The presence
of AllerGen NCE at McMaster has allowed
for major expansion of ongoing research collaborations,
especially in food allergy, asthma and the
development of atopy.
Major Achievements
Dr. Paul Keith currently is serving as the Vice-
President of the Canadian Society of Allergy and
Clinical Immunology and is active on the planning
committee for their annual scientific meeting.
Dr. Susan Waserman is Chair of the Royal
College Specialty Committee for Allergy and
Clinical Immunology.
Building on his accomplishments reported last
year, Dr. Mark Larché and his research team have
developed a vaccine against cat allergy which
is effective and safe with almost no side effects.
Known as “peptide immunotherapy”, a low dose
of the vaccine is given into the skin. Phase III clinical
trials are underway to determine the optimal
dose. This research was published in the Journal
of Allergy & Clinical Immunology.
Future Directions
With all the above activity, maintenance of a
critical mass of academically committed members
of our division is a high priority. The growing
outpatient load and the hospital restructuring
make it necessary to provide greater service to
a larger volume of patients over a larger area.
Moreover, the international stature of research
emanating from our Division and in general
from the Immunology and Infection Program at
McMaster, with new opportunities of linkage to
respiratory health and inflammation through the
CFI endeavour at St. Joseph’s Healthcare, provide
new opportunities for academic growth of
our Division.

78
REPORTS: DIVISION DIRECTORS
Dr. Anne Holbrook
MD, PharmD, MSc, FRCPC
Division Director
Clinical
Pharmacology and Therapeutics
The Division continues to be highly successful in attracting research funding
largely because of a very wide collaborative network within medicine,
pharmacy, nursing, epidemiology, economics and the social sciences.
Educational Activities
Although the Division is the smallest in the
Department, members play a major role in education.
This includes year-round supervision of
medical students and residents on internal medicine
clinical services at St. Joseph’s Healthcare
and Hamilton Health Sciences, as well as elective
rotations through our specialty service. Faculty
members are active supervisors in postgraduate
education at the Masters and PhD level in
Medical Sciences, Pharmacology, Health Research
Methodology and Pharmaceutical Sciences at
both McMaster University and the University of
Toronto. The Division draws Doctor of Pharmacy
students from across the country for clinical and
research rotations, as well as undergraduate pharmacology,
health sciences and statistics students
from McMaster. In addition, the Division is in
constant demand to supervise workshops, electives,
tutorials, academic half days and continuing
medical education sessions.
Clinical Pharmacology and Therapeutics (CPT)
participates in a University of Toronto-coordinated
clinical pharmacology residency training program
accredited by the Royal College of Physicians and
Surgeons of Canada. We are actively recruiting
trainees and graduates. We continue to lobby for
joint specialty-clinical pharmacology training. Our
CIHR-funded training program provides clinical
trainees with high quality evidence on interdisciplinary
research methods and practice.
Research Programs
Despite its small numbers, the Division continues
to be highly successful in attracting
research funding, largely because of a very
wide collaborative network within medicine,
pharmacy, nursing, epidemiology, economics
and the social sciences. Grants come from
a variety of sources, including the Canadian
Institutes for Health Research (CIHR), Ontario
Ministry of Health and Long Term Care, Health
Canada, Canadian Agency for Drugs and
Technologies in Health, national foundations,
professional associations, colleges and, rarely,
pharmaceutical companies. Our research topics
focus on the benefits, harms, economics
and evidence for therapies and include projects
examining methods of improving prescribing,
the impact of electronic medical records and
computer-based decision support, the impact of
changes in drug policies on health and health
care utilization, patient preferences regarding
therapies, the development, dissemination and
implementation of evidence-based guidelines
for therapies, medication assessment and
pharmacist intervention in primary care clin-
ics, medication adherence support, patients’
needs for therapeutic information, electronic
registries and automated data collection for
outcomes research in priority diseases, and
mechanisms of drug interactions. As well as
scholarly papers and presentations, members
of the Division hold multiple copyrights and
patents on research products, software, reports
and guidances.
Major Achievements
The recent Department initiative to quantify and
rank academic activities of all faculty has shown
that clinical pharmacologists are amongst the
very top percentile group.
One of the unique features of our division is its
ability to directly impact professional practice and
patient care through drug policy decision-making.
Our leadership in evidence-based therapeutics
and inter-professional practice leads to multiple
major advisory roles with the federal and provincial
governments, as well as leadership positions
in provincial and national professional societies.
Future Directions
Since therapies are a prevalent and increasingly
costly sector of health care, clinical pharmacologists
with training in medicine, pharmacology and
epidemiology are in high demand but critically
short supply. Thus, a major immediate goal of
the Division is the recruitment of new members
to allow us to address the significant needs for
therapeutics and toxicology consultation, for
education to improve prescribing practices and
medication safety, and to expand our involvement
in health policy and research. Overall, the
Division will proceed with its goal of excellence
in the research, teaching and clinical application
of pharmacologic principles and evidence-based
therapeutics.

80
REPORTS: DIVISION DIRECTORS
Critical Care
We offer a national advanced Critical Care Simulator Course
… using a state-of-the-art laboratory.
Educational Activities
The Critical Care Program continues to offer a
Royal College accredited two-year Fellowship
Program (Program Director: Dr. Tim Karachi). We
currently have 15 national or international fellows
in the Program. The Critical Care Program
offers formal rotations for residents from a
variety of other specialties. There is a formal
selective rotation in critical care being offered to
medical students in their clerkship (Organizer:
Dr. Heather Whittingham), as well as formal electives
to medical students and residents. We
continue to provide a multidisciplinary regional
critical care journal club. There continues to be
Regional Critical Care Rounds hosted by the faculty
(Organizer: Dr. Alison Fox-Robichaud). We
offer a national advanced Critical Care Simulator
Course (Organizer: Dr. Alison Fox-Robichaud)
using a state-of-the-art laboratory. Formal educational
sessions are conducted on a daily basis, as
well as a once weekly regional round (Organizer:
Dr. Mark Soth) for rotating residents during their
Critical Care rotation. Regional weekly rounds
are given by the fellows with faculty supervision.
Research
The Adult Critical Care Fellowship Program mandates
all fellows to complete a research project
Dr. Andreas Freitag
MD, FRCPC
Division Director
under the supervision of faculty. There is an
Annual Fellows Research Day in conjunction
with the Fellowship Program at the University of
Western Ontario. Many of the abstracts/projects
are also presented at a variety of international
conferences with subsequent peer-reviewed publication.
Drs. Deborah Cook and Maureen Meade
co-chair a research mentorship group dedicated
to formal training in research methodology and
stewardship. Members of the Division are active
participants in the Canadian Critical Care Trials
Group dedicated to designing and implementing
multi-centre, multi-national trials in Critical Care
Medicine. Several members of the Division are
either principal or co-investigators in a variety
of trials including studies involving modes of
mechanical ventilation best suited for patients
with ARDS; management/mechanisms in septic
shock; and sedation protocols in ICU, just to
name a few.
Major Achievements
Dr. Deborah Cook remains the Co-chair of the
evidence-based practice centre at McMaster
University as well as the Director of ICU Clinical
Effectiveness and Outcomes Research at St.
Joseph’s Healthcare, Hamilton. She remains
the Academic Chair of Critical Care Medicine at
McMaster University and holds the McMaster
University/St. Joseph’s Healthcare Regional
Academic Chair in Critical Care Medicine, as
well as the Canadian Research Chair of Research
Transfer in Intensive Care.
Through the Ministry of Health there has been
the establishment of Critical Care Response
Teams (RACE); three of which are in Hamilton.
Dr. Peter Kraus sits on a provincial-wide Critical
Care Committee, which advises government
and/or creates policy with regards to future
directions in Critical Care utilization, funding
and standards of care. There is ongoing
financial support for the Clinical Critical Care
Assistants Program sponsored by the Ministry
of Health, Hamilton Health Sciences and St.
Joseph’s Healthcare. Dr. Cindy Hamielec
remains the Medical Director of this program.
Dr. Andy Freitag is the Medical Director for the
Regional Advanced Adult Critical Care Transport
Team. Dr. Draga Jichici, co-founder of the
Canadian Neurocritical Care Society, remains
the co-chair.
We have expanded Critical Care beds both at
the Hamilton General (Medical Director: Dr.
Peter Kraus) and St. Joseph’s Hospital (Medical
Director: Dr. Mark Soth) sites in order to accommodate
our regional mandates in Trauma,
Neurosurgery, Respirology and Nephrology.
We have consolidated ICU beds/resources at
the Juravinski site to further accommodate our
regional mandates in Oncology, Orthopedics
and tertiary care level services (Medical Director:
Dr. Tim Karachi). We have created the Women’s
Reproductive Health ICU based at McMaster
(first of its kind in the region) dedicated to high
risk Obstetrics/Gynecology (Medical Director: Dr.
Andy Freitag).
Future Directions
We will continue to provide support and leadership
in the delivery of Critical Care Services in
Hamilton as well as the LHIN. We are working
with the LHIN to establish a regional chronic
ventilator assessment unit/program based at St.
Joseph’s Hospital.

82
REPORTS: DIVISION DIRECTORS
Educational Activities
The Dermatology Division has continued its commitment
to undergraduate teaching. This year,
Malignant Melanoma and Pemphigus Vulgaris
patients have been introduced into the MF4 tutorial-based
learning. This will significantly expand
the learners’ introduction to skin oncology, immunology,
surgical and medical management, disease
prevention and early detection. The learner
is connected to an expanded E-learning library
including basic morphology and skin immunology.
This is complemented by a Melanoma Elearning
module.
The annual Day in Dermatology, combining
lecture format and clinical viewing, are offered
in MF4. Students consistently rank this as an
excellent learning opportunity. The McMaster/
Waterloo/St Catharines sites join via satellite for
lectures and involve local dermatologists for the
patient viewing component.
Large group sessions continue to be provided in
addition to the pre-LMCC lecture. Clinical rotations
are organized for undergraduate medical
students, Family Medicine residents and PGY1
Internal Medicine residents. Block and horizontal
electives are offered by Drs. Muhn, Edstrom,
O’Malley, Rosen, Saveriano, Vender, Vignjevic,
Murphy, Wismer and Lima.
Dr. Judy Wismer
MD, FRCPC
Division Director
Dermatology
Attracting and retaining well-trained, academic dermatologists
continues to have the highest priority.
Members continue to lecture nationally and internationally.
Journal club and clinical teaching
rounds are held monthly.
Clinical Recruitment
The Division welcomes a new GFT faculty member,
Dr. Hermenio Lima. Dr. Lima obtained his
MD from Universidade Federal Do Ceara in Brazil
in 1989. He completed his PhD in 1995 from
Harvard School of Public Health. His major was
Immunology and minor was Molecular Biology
and Tropical Medicine. In 2000, Dr. Lima was
promoted to Full Professor of Dermatology
at Universidade Federal De Santa Catarina.
Furthermore, from 2003-2007 Dr. Lima was
an Assistant Professor and Head of Clinical
Immunology and Allergy at Universidade Federal
Do Parana in Brazil. He also held the position
of Professor of Dermatology, which was a cross
appointment, from 2003-2008. From 2008 to 2010,
Dr. Lima was a Research Fellow in the Department
of Dermatology at Harvard Medical School. His
main research interests are autoimmune skin
disease as well as skin manifestations of tropical
diseases. To date, Dr. Lima has published 47
peer-reviewed articles, one book and three book
chapters. Dr. Lima’s clinical responsibilities will
be both at the Waterloo and McMaster campuses.
He is also committed to ongoing research and
teaching responsibilities. We welcome Dr. Lima
to our division.
Dermatology Residency Program
This has been the inaugural year for the combined
McMaster/University of Toronto dermatology
residency program. Dr. Kristy Bailey joins
us from an MD, University of Ottawa; MSc,
University of Toronto. She spends PGY1-2 years
at McMaster and dermatology electives subsequently
in the PGY3-5 years. She combines the
excellence of the Internal Medicine Residency
experience with Friday half-days at the University
of Toronto -- an established dermatology residency
program.
The goal of this program is to provide an outstanding
learning opportunity for excellent candidates
who may consider future practice within
the greater Hamilton area.
Future Directions
Attracting and retaining well-trained, academic
dermatologists continues to have the highest
priority. This is in addition to the planning and
implementation of the joint dermatology training
program. A melanoma screening clinic continues
to be a much needed addition to the present service
model. Dermatology continues to be present
in the discussions and planning of the new and
expanding McMaster outpatient clinic.
Clinical Activities
Dermatologists continue to blend clinical practice
in private offices with hospital-based service
including teaching clinics at 3V2 McMaster (Drs.
Wismer and Lima), non-melanoma skin cancer
clinic at the Juravinski Cancer Centre (Drs.
Muhn and Rosen), and Vascular Anomalies Clinic,
McMaster site (Dr. O’Malley). Hospital consultative
service and on-call weekend coverage continues
to be provided.

84
REPORTS: DIVISION DIRECTORS
Dr. Margaret Ackerman
MD, MSc, FRCPC, MEd,
Division Director
Emergency
Medicine
The clerkship rotation continues to grow with the expansion of
the Medical School and is recruiting community hospitals to
participate in emergency medicine placements.
Educational Activities
The Postgraduate Program is flourishing under
the leadership of Dr. Ian Preya who is now
into his second year as Program Director. The
Program was very successful in the CaRMS
match and everyone is pleased with the quality
of the applicants who chose to train at McMaster
University. There are now 32 residents from the
PGY1-5 in the Royal College program and 6 in
the CCFP(EM). In addition, the Division provides
clinical training and supervision to 180 off service
residents. The important role of CTU director is
capably managed by Dr. Rebecca Mallin at HHS
and Dr. Joe Cherian at SJHH.
Dr. Karen Schiff has assumed the role of Assistant
Program Director from Dr. Josh Williams who
has moved to Kelowna, BC. Just before leaving,
Dr. Williams won the 2011 PAIRO Excellence in
Clinical Teaching Award for McMaster University.
Dr. Paul Miller was awarded the Outstanding
Contribution to the RCPSC Residency Program by
the residents.
Last winter was the first Clin Epi Blitz, a review
course directed at residents and fellows planning
to write their fellowship exams. The course evaluations
were very positive so planning is underway
for this year.
The clerkship rotation continues to grow with the
expansion of the Medical School and is recruiting
community hospitals to participate in emergency
medicine placements. Components of the curriculum
are being developed to be available as
online resources in Medportal. The 2011 School of
Medicine Emergency Medicine Clerkship Teaching
Award went to Dr. Cathy Sellens, and the Division
Undergraduate Teacher of the Year was Dr.
Jonathan Jowett.
The BEEM course was held in two venues last
year, SkiBEEM at Silver Star in BC for the skiers,
and SteelBEEM in Hamilton. The recent annual
EBEM course was well attended with 100 participants
from the region and included nurses, paramedics,
and physicians.
Research Activities
To enhance research activity in the Division, a
clinical epidemiologist, Wendy Bhanich Supapol
joined the group. She has been working with the
residents to increase the quality of their research
projects and with Dr. Andrew Worster, Research
Director. The Division recently received the first
Hamilton Niagara Halidmand Brant LHIN ESSC
grant for “Measuring and improving quality of
care in the Emergency Departments of the HNHB
LHIN: Knowledge Generation and Transfer.” The
Division is looking forward to a further increase in
research activities.
Dr. Teresa Chan as a PGY-3 won two awards in
the past year, the 2010/2011 RMA Scholarship and
the 2011 Royal College Fellowship for Studies in
Medical Education (SME). She is using the latter
to further her education in the MEd Program at
the University of Chicago.
At the annual Resident Research Day, Dr. Julian
Owen, PGY-3, won the Study Design Award
and Dr. Julien Payrastre, PGY 5 won for best
Original Research.
Major Achievements
Dr. Jonathan Sherbino was awarded the 2011
Meridith Marks New Educator Award and was
elected as a Fellow of the Academy of Medical
Educators (UK).
The most important award in the Division of
Emergency Medicine is for Excellence in Teaching
and includes evaluations and comments from
both Undergraduate and Postgraduate students.
It was given to a most deserving member of
the Division, Dr. Andrew Healey. In addition to
his overall teaching activities, he should be recognized
as a leader in the use of Emergency
Department Bedside Ultrasound.
Future Directions
Members of the Division will continue to provide
quality emergency care in three hospital
Emergency Departments and two Urgent Care
centres, treating over 200,000 patients annually
and training medical students and residents. The
continual challenge is maintaining clinical service
while supervising learners. With the expanding
role of focused ultrasound in the provision of
clinical care, the identification of quality indicators
and translation to direct patient care, and
the commitment of the members to teaching the
impact will be improved patient outcomes.

86
REPORTS: DIVISION DIRECTORS
Educational Activities and Roles
1. Undergraduate Medicine
a. Coordination of Medical Foundations 2
(MF2) and its endocrine subunit
b. Planning and leading large group sessions
c. Tutoring in MF2, MF3 and clerkship, and
clinical skills preceptorships
d. Advising for the McMaster University
Medical Journal
e. OSCE examinations
2. Postgraduate Medicine
a. Teaching on the CTU
b. Co-chairing the McMaster University
Internal Medicine Review Course
c. Clinical electives in Endocrinology and
Metabolism
d. Monthly city-wide Endocrine/Metabolic
Grand Rounds and Journal Club
e. Directing the International Health
Program for Internal Medicine
f. Program Director of Medical Biochemistry
Residency
Dr. Hertzel C. Gerstein
MD, MSc, FRCPC
Division Director
Collaborative research across disciplines is the
key distinguishing characteristic of the division.
Endocrinology
and Metabolism
3. Postgraduate Health Research Methodology
and Other Programs
a. Several postdoctoral & MSc students
b. Several thesis committees and chairs
c. PhD comprehensive exams and PhD
exams
4. Other Education Including CME, and General
Public Education
a. Organization of one diabetes and one
endocrinology CME Program
b. Faculty for CME events for family physicians,
specialists, and allied health professionals
in more than 100 local, national
and international forums
c. Organization of annual diabetes public
forum with > 600 attendees
d. Quarterly publication of the Diabetes
Hamilton publication “Knowing Diabetes”,
and distribution to all family MDs and
4,200 people with diabetes
e. Editorial consultant for American
College of Physicians – PIER ( Physicians
Information and Education Resource)
module on hypercalcemia
f. Editorial board memberships for several
journals
g. Chair/Co-chair/Committee for:
i. Canadian Diabetes Association
Clinical Practice Guidelines
ii. Doctors for Humanity Public Forum
(an international organization dedicated
to improving wellbeing by providing
access to advances in Medicine);
iii. Premenopausal Osteoporosis
Guidelines project;
iv. Evaluation committee for the
Physician Assistant Program;
v. Scientific program of an international
diabetes symposium
Research Programs
Collaborative research across disciplines is the key distinguishing
characteristic of the division. All members
of the Division are directly or indirectly involved
in research. Several members are pursuing
an extensive program of basic and/or clinical
research related to obesity, diabetes, dysglycemia,
cancer and cardiovascular disease, bone
diseases, and osteoporosis. These are done in
close collaboration with the Population Health
Research Institute, members of other divisions,
the Department of Clinical Epidemiology and
Biostatistics, the Centre for Evaluative Medicines,
and other universities around the world. They
include:
1. Receipt of five new operating grants from
peer-review agencies or industry;
2. Piloting therapies to induce Type 2 diabetes
remission;
3. Publication of more than 28 peer-reviewed
articles or chapters in the 2010-2011 academic
year;
4. Metabolic causes of inactivity, obesity and
dysglcyemia and the role of AMP kinase;
5. Basic and clinical research related to the
causes and consequences of dysglycemia;
6. International leadership of, and participation
in, several international clinical trials of various
approaches to prevent serious health outcomes
in dysglycemic individuals;
7. International leadership in osteonecrosis,
bisphosphonate therapy, and metabolic bone
diseases;
8. Service on two international DSMBs
Major Achievements
1. The Endocrinology and Metabolism postgraduate
training program successfully recruited
its 2nd subspecialty fellow who begins in July
2011.
2. Dr. Natalia Yakubovich joined the Division and
is now based at MUMC.
Future Directions
1. Ongoing recruitment
2. Developing/assessing innovative educational
approaches for patients and physicians
3. Ongoing research assessing:
a) Molecular mechanisms by which obesity
causes insulin resistance/Type 2 diabetes;
b) Role of fats and inflammation as major
contributing factors causing the metabolic
disturbances observed with obesity;
c) How and why exercise prevents/reverses
Type 2 diabetes;
d) Causes and consequences of dysglycemia
and obesity;
e) Role of perioperative dysglycemia;
f) Bone health and calcium disorders.

88
REPORTS: DIVISION DIRECTORS
We are one of the top two GI research groups in Canada
and one of the top ten worldwide.
Educational Activities
The popularity of the Division of
Gastroenterology’s national endoscopy training
programs continues to grow. This includes a
“Train the Trainers” course and the sixth annual
McMaster Residents’ Endoscopy Training Course.
Dr. David Armstrong, Dr. Frances Tse and Dr.
John Marshall organize this course, with invaluable
support from the English NHS National
Endoscopy Training Lead, Dr. John Anderson.
The course has increased in popularity annually
with GI residents from Vancouver to Halifax
attending. The Gastroenterology Resident Training
Program is one of the most highly regarded in
Canada, under the leadership of Dr. Frances Tse
as program director. Dr. Eric Greenwald has been
appointed as Medical Foundations 2 Director.
Research Programs
The Division has been at the forefront of GI
research for almost 30 years, culminating in
the creation of the Farncombe Family Digestive
Health Research Institute (FFDHRI) thanks to a
generous gift of $15 million from the Farncombe
family. Dr. John Wallace is the inaugural Director
of the FFDHRI and many of the GI Division faculty
are also members of the Institute. The close
proximity between clinicians and scientists with
Dr. Paul Moayyedi
BSc, MB, ChB, PhD, FRCP, FRCPC, AGAF, FACG
Division Director
Gastroenterology
diverse disciplines such as immunology, physiology
and microbiology has provided an environment
for truly innovative bench-to-bedside
research. The FFDHRI houses the Farncombe
Family Gnotobiotic Facility, the only germ-free
facility in Canada. Together with the metagenomic
lab and the 454 sequencer, this will allow us to
understand how gut flora interact with the host to
cause disease in the GI tract and beyond.
The Upper Gastrointestinal and Pancreatic
Diseases (UGPD) Cochrane Review Group also
has its base within the FFHDRI under the leadership
of Dr. Paul Moayyedi with Dr. Grigoris
Leontiadis as Deputy Editor. This produces
high quality systematic review published in the
Cochrane Library that informs clinicians and
patients worldwide on evidence-based medicine.
We are one of the top two GI research groups in
Canada and one of the top ten worldwide. GI division
members have published over 2,500 papers
that have been cited almost 72,000 times. Three
members (Drs. Wallace, Collins and Hunt) have
an h-index over 50 (a value over 40 indicates an
“outstanding scientist”). In 2010 work from the GI
division was cited over 6,100 times.
Major Achievements
Dr. John Wallace was awarded the William
Harvey Medal for Outstanding Contributions to
Science during the 25th Anniversary celebrations
of the William Harvey Research Institute
in London, England. Dr. David Morgan is the
current President of the Canadian Association
of Gastroenterology, and Dr. Paul Moayyedi is
the joint Editor-in-Chief of the American Journal
of Gastroenterology. The Canadian Institutes of
Health Research announced $9.6 million in funding
to Cochrane Canada and part of this grant will
fund the UGPD Cochrane Review Group over the
next 5 years. Dr. Elena Verdú received the Masters
Award in Gastroenterology at the 2011 American
Gastroenterology Association meeting for her outstanding
contributions to research. She was also
awarded a Canada Research Chair.
Future Directions
The Farncombe Family Digestive Health Research
Institute will provide an innovative environment
with the collaboration of clinical and basic science
researchers. Our challenge is to maintain this
integrated approach of bench-to-bedside research
with the reorganization of health care in Hamilton.
Our goal is to unravel how nutrition and gut flora
interact with the intestinal mucosa to produce
health and disease. This applies not only to disorders
of the digestive tract, but has implications
for diseases in all organ systems.
Type 1 diabetes and celiac disease
Insulitis develops in a gnotobiotic model after gluten challenge and T
regulatory cell depletion (Galipeau et al J Immunol 2011 – Verdu lab)

90
REPORTS: DIVISION DIRECTORS
Dr. Akbar Panju
MB, FRCPC, FRCP(Edin) FRCP(Glasg), FACP
Division Director
General
Internal
Medicine
The Division of General Internal Medicine has a dedicated group of
academic general internists who devote a significant proportion of time
to educational and scholarly activities on our Clinical Teaching Unit.
The last 12 months have been very exciting for
the Division of General Internal Medicine. The
Division continues to be vibrant and has been
able to accomplish its academic mandate in
education and research, and at the same time
maintain clinical services at our academic health
sciences centres in Hamilton.
In April 2011, as part of Access to the Best Care,
the Clinical Teaching Unit at McMaster University
Medical Centre was transferred to the Juravinski
site with a lot of planning and involvement from
individuals within in the Division of General
Internal Medicine. The transition of the CTU from
MUMC to Juravinski was a smooth one. We
now have an extremely vibrant and busy Clinical
Teaching Unit at Juravinski site and the feedback
we have received so far from the learners has
been extremely positive. I would like to mention
the hard work and dedication provided by
Dr. Ameen Patel, previous CTU Director at the
McMaster site and now at the Juravinski site; Dr.
Dereck Hunt, Site Lead for GIM at the Juravinski
site; Dr. Parveen Wasi, past Director of Internal
Medicine Residency Program; and Dr. Shariq
Haider the new Director in Internal Medicine
Residency Program.
In addition to the creation of the new Clinical
Teaching Unit at the Juravinski site, we have
maintained a vibrant CTU at the Hamilton General
site and at St. Joseph’s Healthcare.
The Division of General Internal Medicine has a
dedicated group of academic general internists
who devote a significant proportion of time to
educational and scholarly activities on our Clinical
Teaching Unit. The time commitment and dedication
of each and every member in the Division
has been greatly appreciated. With the new models
of care and admission of new patients, there
has been a major commitment by the internal
medicine physicians to come early in the morning
to accept new patients on a daily basis for the
month they are on the Clinical Teaching Unit.
One of the challenges the Division is facing is in the
management of non-clinical teaching unit patients
(non-teaching patients or what we call MD Based
Team patients). Each of the CTU teams has been
capped to 25 patients and after that cap, the patients
are being cared for by the non-teaching/MD Based
Team. Presently, there is inequality of resources at
each of the sites for the MD Based Team.
The Executive of the Division of GIM (Drs. A.
Panju, A. Patel, S. Haider, C. Bradley, R. Hanmiah,
J. McMullin, D. Hunt) with the help of Annette
Rosati and Kevin Sulewski has produced a visioning
document for academic general internal
medicine called “Academic Internal Medicine - A
Sustainable Future” and this document has been
circulated to leaders at Hamilton Health Sciences
and St. Joseph’s Healthcare. The document
articulates clearly the challenges and solutions
facing academic general internal medicine at
McMaster University, and we are quite confident
that the administration and the leadership at our
institutions will study the document and help the
Division in solving some of the challenges.
The Division has been fortunate in recruiting high
caliber general internists over the last 12 months
and the individuals are Dr. John Neary and Dr.
Zahira Khalid, who have joined General Internal
Medicine at St. Joseph’s Healthcare. We have
been fortunate in having Dr. Christian Kraeker,
who has joined the General Internal Medicine
Team at Juravinski site. We have two Clinical
Scholars who have been identified for potential
recruitment at the Hamilton General site starting
July 2012.
Dr. Sanjit Jolly, assistant professor, medicine, performing a radialaccess
coronary angiography at the Hamilton General Hospital’s Heart
Investigation Unit, with assistance from registered nurse Lisa Boyd.
The Division of General Internal Medicine held
a very successful 3rd Review Course in Internal
Medicine in April 2011. It was attended by over
500 individuals and the feedback we received was
exemplary. We are in the planning phase to have
the 4th Annual Review Course in March 2012.
The Division meets on a quarterly basis for a
dinner meeting and the attendance has been
over 85%. At these meetings we discuss specific
details from each of the sites. A lively discussion
usually follows and at the end of the meeting we
come to some consensus and direction for the
Division. The group is made up of collegial individuals.
In addition to academic general internal
medicine, we are fortunate in having subspecialists
who have a secondary appointment in GIM.
We are planning to ensure that we have a vibrant
research program for the Division of GIM and Dr.
John You has been leading the research activities
for the Division.
We have been fortunate in attracting GIM Fellows
for the positions in the academic General Internal
Medicine Training Program and Dr. Raj Hanmiah
and his group have been working tirelessly to
ensure that we create an outstanding program.
For the next academic year, we had over 35 applicants
and we hope to fill the positions with outstanding
individuals.
Overall, the Division has been busy with clinical,
educational, and scholarly activities. We are fortunate
in having an excellent group of individuals who
are committed to General Internal Medicine’s mandate
of clinical, education, and research activities.
I am very fortunate in leading this vibrant group
of individuals.

92
REPORTS: DIVISION DIRECTORS
Educational Activities
The Division has remained very active serving
over 150 undergraduate and postgraduate
learners rotating through our geriatric medicine
programs. This past academic year has been
extremely successful under the leadership of our
educational leaders Drs. Cowan, Allaby, Didyk,
Gagnon, St. Onge, Marr, McLeod, Misiaszek,
and Woo.
The Division hosted Dr. Michael Gordon, visiting
professor from the University of Toronto; Dr.
Jayna Holroyd-Leduc, visiting professor from
Calgary University; and Dr. Pam Jarrett visiting
professor from Dalhousie University. Monthly
geriatric grand rounds were held locally at the
Juravinski Hospital and each has been video-conferenced
to more than 10 community locations.
The Division also welcomed its new residents
Drs. Fiona Menzies, Abdulaziz Al-Rasahed, and
Rana Al-Hamwy. With growing interest in geriatric
medicine, the postgraduate residency Geriatric
Interest Group (GIG) has been under development
with leadership and support from our division
members and internal medicine residents. The
undergraduate Inter-professional GIG continues to
be successful and holds its annual interdisciplinary
workshop at multiple campus sites with Dr.
Woo as their faculty advisor.
Dr. Sharon Marr
MD, FRCPC, MEd
Division Director
Our division will strive to ensure that the needs of
the frail elderly are addressed.
Geriatric
Medicine
The Division collaborated with the Regional
Geriatric Program, Central to provide excellence
in education and capacity building through the
development of innovative and successful educational
programs related to seniors and frail elderly
persons. Our division has had strong leadership,
collaboration and presence at many educational
events including the Regional Geriatric Program
Central Cognitive and Geriatric Assessment
Training Workshops, Hospital Elder Life Program
(HELP) and other McMaster University geriatric
educational events. Drs. Gagnon and Heckman
have partnered with Dr. Linda Lee to develop and
implement a novel and effective model for Family
Medicine Memory Clinic Training Programs within
the HNHB LHIN and other provincial LHINs. This
model of capacity building has been awarded
a grant from the Ontario College of Family
Physicians. Drs. Patterson and Cowan have also
partnered with Family Health Teams (FHT) within
Hamilton to provide geriatric expertise and capacity
building and have been successful in meeting
the needs of FHT’s and their patients and health
care providers.
Thank you to Dr. Heckman, who has stepped
down as the Geriatric Medicine Residency
Research Program Director, for his dedication and
support to this program and our geriatric fellows.
Congratulations to Dr. Didyk who was appointed
the Internal Medicine postgraduate Regional
Educational Leader for the Waterloo Campus,
which will have its inaugural Internal Medicine
residency-training program as of July 2011.
Research Programs
The Division continues to have a number of outstanding
and successful research endeavors and
projects such as “A knowledge to action intervention
in long term care – A feasibility study focusing
on the uptake of osteoporosis and fracture
prevention best practices” and the “Development
of bone quality parameters for assessing osteoporosis
using peripheral quantitative computed
tomography” (CI. Dr. Papaioannou, CIHR funded
grant); Ontario Survey evaluating bisphosphonate
use and osteonecrosis of the jaw in Ontario (PI Dr.
Khan); Family Medicine Memory Clinic Training
Program funded by a grant from the Ontario
College of Family Physicians (Co PI Drs. Gagnon,
Heckman and Lee); Summary of Senior Friendly
Care in Hamilton, Niagara, Haldimand, Brant
(HNHB) Local Health Integration Network (LHIN)
Hospitals” (Co-Author Dr. Marr). In addition,
Dr. Papaioannou leads the Ontario Ministry of
Health and Long-Term Care Strategy for Fracture
Prevention in Long-term Care. She was also the
lead author of the 2010 Osteoporosis Canada
Guidelines (CMAJ) that included the development
of a knowledge translation strategy to ensure
the guidelines are disseminated to primary care
and patients. The focus of the guidelines was the
targeted assessment and treatment of high-risk
patients for fractures and introduced a new 10year
fracture risk assessment model.
We also want to thank and acknowledge Dr.
Papaioannou who has been appointed the
Research Director for the Division of Geriatric
Medicine. Her appointment will no doubt ensure
that our division members are supported in their
research endeavors and our research opportunities
will develop and grow.
Lastly, we want to thank Dr. Molloy for his contributions
as a renowned researcher in the area
of dementia and advanced directives. He has
accepted a position at Cork University in Ireland
as the Chair of the Centre of Gerontology and
Rehabilitation in September 2010.
Major Achievements
Congratulations to Dr. Gagnon who received
the Postgraduate Residency Teacher of the Year
award, Department of Medicine, and the Regional
Geriatric Program Central Executive Senior
Leadership Award. The St. Joseph’s Healthcare
(SJH) geriatric program was awarded the Best
Sub-specialty Rotation within the Department of
Medicine. Dr. McLeod was awarded the prestigious
W. Watson Buchanan AFP Clinician Educator
Award, Department of Medicine Internal Career
Award. Dr. Khan was awarded the International
Clinician Instructor Award in the field of metabolic
bone disease. Dr. Woo was awarded the Medicine
Clerkship Faculty Teaching Award at this year’s
inaugural Medicine Clerkship Program Award’s
ceremony. The Division of Geriatric Medicine,
in recognition of Dr. Turpie’s outstanding leadership
and mentorship in education at McMaster
University, has established an annual undergraduate
award, which was awarded to Ms. Amy
Montour, McMaster University MD Class 2011.
Future Directions
The Division will continue to develop strong leadership
and collaborative partnerships with each
of its academic health science centre partners,
Regional Geriatric Program Central, Ministry
of Health and Long Term Care, and community
stakeholders. Our division will strive to ensure
that the needs of the frail elderly are addressed.
We will continue to optimize their chronic health
conditions and prevent further medical and functional
deterioration whenever possible, to educate
and train future generations of interdisciplinary
health professionals in the care of the elderly
persons, and to promote and develop research
programs that optimize the care and functional
independence of older persons.
Our division would like to thank Dr. O’Byrne,
Ms. Rosati and their administrative and finance
department staff; Mr. Sulewski; Dr. Lumb,
Hamilton Health Sciences (HHS) and St. Peter’s
Hospital; Dr. Russell, SJH; Ms. Pacheco; Ms.
Voogd; and our administrative staff for their ongoing
support and dedication for our Division of
Geriatric Medicine. I would also like to thank Drs.
Misiaszek and Gagnon for their support and guidance
as geriatric site chiefs at HHS and SJH.

94
REPORTS: DIVISION DIRECTORS
The Division of Hematology and
Thromboembolism at McMaster University
is an internationally recognized leader for its
research, education and clinical excellence. The
Division is one of the largest such divisions in
North America, and delivers a complete range of
clinical, academic, administrative and research
services. Our faculty continues to occupy important
positions on local, national and international
stages in each of these four domains.
Educational Activities
Faculty members span four departments:
Medicine, Pathology and Molecular Medicine,
Pediatrics and Oncology. Members contribute
importantly to educational activities in all departments,
both at the undergraduate and postgraduate
levels. Additionally, our faculty members hold
cross-appointments in Biochemistry and elsewhere
in the broader university, where they also
contribute importantly to educational activities.
The 2010/2011 educational year saw the implementation
of the first major changes to our hematology
residency training program in more than
20 years. In response to changing expectations
from the Royal College, and as a result of careful
analysis of the CANMEDS competencies, we have
included a Junior Attending rotation, reduced
the commitments to inpatient hematology ward
Dr. Mark Crowther
MD, MSc, FRCPC
Division Director
Hematology
and Thromboembolism
The Division participates actively in undergraduate MD teaching
and in the training of residents from Infectious Diseases, Internal Medicine,
Anesthesia, Family Medicine, Neurology and Critical/Intensive Care.
service, included a Medical Oncology experience
and refined our expectations around elective and
research experiences. June 30, 2011 saw a landmark
event with the “retirement” of Dr. Parveen
Wasi from the position of Director for the Internal
Medicine Residency Training Program. Dr. Wasi’s
tenure was marked by excellence of the highest
degree: Achievements include the National
Residency Program Director of the Year award and
numerous accolades, both internal and external.
As Dr. Wasi stepped out of her role, the division
of Hematology and Thromboembolism also lost
a strong supporter with the retirement of Ms.
Gail Trevisani, who supported both Hematology
and Thromboembolism and other subspecialty
Training Programs in her position as coordinator
of the Residency Training Programs within the
Department of Medicine.
Research Program
The research productivity of the Division of
Hematology and Thromboembolism remains
strong. Publications in leading journals, including
the Annals of Internal Medicine, New England
Journal of Medicine, Blood, Circulation and
other high impact journals were seen throughout
the year. Among the many successful
researchers in the Division of Hematology and
Thromboembolism, Dr. John Eikelboom has
established himself as an international expert
examining the interface between hematology
and cardiac disorders. Dr. Eikelboom, working
closely with colleagues from the David Braley
Cardiac, Vascular & Stroke Research Institute, was
involved in a series of publications examining
how novel antithrombotic agents may reduce the
risk of stroke in patients with atrial fibrillation.
Numerous members of the faculty have been
involved in the 9th American College of Chest
Physicians Guidelines on Antithrombotic Therapy.
This guideline is the “reference standard” for the
care of patients with, or at risk of, both arterial
and venous thrombosis. Successes also continued
in pediatrics, oncology and laboratory medicine.
Dr. Ted Warkentin continues his “world leading”
research into heparin-induced thrombocytopenia.
Dr. Menaka Pai, to be recruited to faculty
in July 2011, continued her work examining how
to improve our use of proven therapies in high
risk patients. Her work has received funding from
several external sources and promises to change
the way we provide venous thromboembolism
prophylaxis to high risk patients.
Major Achievements
The 2010/2011 academic year saw the amalgamation
of malignant hematology from a two-site to
a one-site model. This reorganization was accomplished
with remarkable efficiency. The development
of a new culture of excellence in malignant
hematology is well underway at the brand-new
Juravinski hospital. October 2010 also marked the
40th anniversary of the first residents to training
hematology at McMaster. Marked by a special
conference that attracted attendees from across
Canada and internationally, this conference reinforced
McMaster’s position as a leading academic
hematology program.
Future Directions
The Division of Hematology and
Thromboembolism will continue to strive to
remain the pre-eminent such division in North
America. We anticipate that our current and future
clinical fellows, including Dr. Vinai Bhagirath, Dr.
Kylie Lepic and others will undertake advance
training potentially leading to their recruitment.
We will continue to develop strength in malignant
hematology research, build on our excellence in
thromboembolism and expand our capacity for
research in other aspects of hematologic care
such as transfusion medicine, immune mediated
hematologic disorders and laboratory investigations
of hemoglobinopathy. Under the leadership
of Dr. Madeleine Verhovsek we anticipate
establishing a focused hemoglobinopathy clinic,
and with additional recruitment to the Hamilton
General Hospital site we anticipate building a
center of excellence in inpatient and outpatient
hematologic care.

96
REPORTS: DIVISION DIRECTORS
Dr. Mark Loeb
MD, MSc, FRCPC
Division Director
Infectious
Diseases
We will continue to expand studies using biomarkers, such as
genetic and immunologic studies, and continue to work closely
with colleagues doing bench research.
Educational Activities
Under the leadership of Residency Program
Director Dr. Philip El-Helou, the Division partici-
pates actively in undergraduate MD teaching
and in the training of residents from Infectious
Diseases, Internal Medicine, Anesthesia, Family
Medicine, Neurology and Critical/Intensive
Care. The Division shares trainees with Medical
Microbiology in the program headed by Dr.
Cheryl Main. Our residents presented their
research at various national meetings includ-
ing the Association of Medical Microbiology and
Infectious Disease Canada. Dr. Mazen Bader was
awarded the McMaster Infectious Disease and
Medical Microbiology Faculty Teaching Award.
Dr. Martha Fulford supervised Julia Morinis, a
pediatric resident, who presented this case at the
Canadian Pediatric Society conference in July
2010 and won the Trainee Clinical Case competi-
tion. Dr. Main was an invited speaker at the The
Royal College of Physicians and Surgeons of
Canada on tools to promote CanMEDS teaching
and evaluation in Laboratory Medicine. Under
the supervision of Drs. Haider and Johnstone,
Jocelyn Srigley, a medical microbiology/infectious
diseases fellow, published a paper on tetanus.
Research Programs
Dr. Smaill was an invited speaker at three international
meetings for infections in pregnancy,
including the 50th Interscience Conference
on Antimicrobial Agents and Chemotherapy
Conference. Drs. Johnstone and Loeb are conducting
a CIHR study examining immune phenotypes
related to influenza infection in nursing
home residents. Dr. Loeb was awarded a $10
million NIH contract to study genetic associations
that predispose to severe dengue in seven
countries in South America and South East Asia.
Drs. Loeb, Mertz, and Johnstone were awarded
a contract from the WHO to conduct a systematic
review on outcomes of influenza. Drs. Loeb
and Johnstone are conducting a study to assess
immune response and genetic determinants of
zoster vaccine in nursing home residents. Dr.
Smieja is conducting a study in university students
to assess predictors of influenza infection.
Dr. Smaill is continuing to conduct a vaccine trial
for tuberculosis.
Major Accomplishments
In July 2011, Dr. Daniela Leto will be recruited
as clinical educator for Hamilton Health
Sciences, and Dr. Haider will be appointed
Program Director Internal Medicine Residency
Program. Dr. Martha Fulford was appointed as
the Medical Director of the GIMRAC clinic at
Hamilton Health Sciences and served on communicable
diseases advisory committee for the
Ontario Public Health Agency. Dr. Fulford also
co-authored a textbook on zoonotic diseases.
Dr. Main served as Chair of the Internal Review
for the Royal College Neurosurgery program
and reviewer for the Medical genetics training
program. Dr. Jennie Johnstone received a CIHR
fellowship. Dr. Mertz completed his HRM MSc
degree. Dr. Loeb led a study on influenza immunization
in Hutterite children that was voted as
the Lancet paper of the year and was reported
on in the New York Times. Dr. Loeb was Chair
of a Centers for Disease Control and Prevention
Special Emphasis Panel on Virologic Evaluation
of the Modes of Influenza Virus Transmission
and was an invited speaker at the Interscience
Conference on Antimicrobial Agents and
Chemotherapy Preventing Nosocomial Influenza
at the Options Influenza meeting. Dr. Smaill
was made a member of the Death Investigation
Oversight Council, Ministry of Community Safety
and Correctional Services for Ontario. Dr. Tim
O’Shea was made Director of Quality and Patient
Safety for Department of Medicine.
Future Directions:
We hope to recruit another clinician scientist to
the ID Division. We will continue to expand studies
using biomarkers, such as genetic and immunologic
studies, and continue to work closely with
colleagues doing bench research. Division members
will continue to engage in various aspects of
vaccination research.

98
REPORTS: DIVISION DIRECTORS
Dr. Alistair Ingram
MD, FRCPC
Division Director
Nephrology
The Division is recognized for the excellence of its clinical care,
both dialysis and transplantation, and that remains our guiding and
driving principle.
Educational Activities
The Division of Nephrology continues to be very
active in both undergraduate and postgraduate
medical education. In terms of undergraduate
medical education, all members of the Division
continue to serve as tutors in MF1, MF2 and MF3
as well as clerkship. The Division offers a clerkship
rotation on the inpatient services which has
been very popular. Dr. Robert Yang is the Renal
Unit Planner for the undergraduate program. Dr.
Azim Gangji is the clerkship coordinator for the
Nephrology inpatient rotation.
There are currently three fellows pursuing specialty
training in Nephrology through the training
program. After the successful Royal College
review three years ago and under the directorship
of Dr. Darin Treleaven, we continue to see considerable
interest in coming to McMaster to train.
The Division continues to offer post-subspecialty
training for those pursuing careers in Academic
Nephrology. Dr Christine Ribic is currently pursuing
post-subspecialty training under the supervision
of Drs. Deborah Cook (McMaster) and Ulf
Meier-Kreische (Florida), funded by a scholarship
from Astellas.
The Division plays a major role in the Internal
Medicine training program, with upwards of 20
trainees rotating through for two-month blocks
throughout the year. Training is provided in inpatient
nephrology and transplantation, as well as
outpatient clinics. Very popular initiatives in simulated
procedures, such as central line insertion,
and evaluation exercises, such as the Nephrology
ROSCE, have been rolled out. Drs. Gangji,
Treleaven and Yang lead the activities in this area,
judged as the top clinical experience in the training
program last year.
Research Programs
The research mission of the Division continues
to grow apace. The Hamilton Centre for Kidney
Research (HCKR), led by the Amgen Chair of
Nephrology research, Dr. Richard Austin, is highly
successful and holds around $2 million in yearly
operating and salary support funding. More than
20 students at master’s and PhD levels work
in HCKR labs, as well as numerous technicians
and post-doctoral fellows. A focus in developing
links with the Division of Urology and fostering
growth of research in prostate and renal cancers
has also developed, with original observations on
prostate cancer tumorigenesis published this year
in Nature Communications by Dr. Damu Tang, a
Division of Nephrology PhD and investigator in
the HCKR. Dr. Austin continues to pursue several
funded lines of investigation, regularly appear-
ing in high-impact journals. Clinician-scientist,
Dr. Joan Krepinsky, publishes highly regarded
work in both diabetic and hypertensive renal disease
in the highest impact nephrology journals,
and she and Dr. Austin secured CIHR support for
new work examining endoplasmic reticulum (ER)
stress in the pathogenesis of uremic vasculopathy.
Dr. Peter Margetts has extended his long term
interest in angiogenesis and peritoneal membrane
injury into the kidney itself, where similar
processes appear to underlie scarring. Dr. Jeff
Dickhout, the inaugural holder of the Divisional
Junior Researcher salary award, secured CIHR
operating funding for studies on the role of ER
stress in progressive renal injury and comes on
as a full Assistant Professor in January 2012.
Almost without exception, HCKR researchers all
continue to hold CIHR operating funding, despite
the current environment, in addition to numerous
other operating awards.
In clinical research, Dr. Michael Walsh’s large
study of plasmapheresis in severe vasculitis is
actively and successfully recruiting, funded by
several million dollars in peer-reviewed funding
from agencies in Canada, the UK and the US. He
also holds very substantial international funding
for ongoing work in perioperative renal injury,
and has several ongoing initiatives with PHRI.
Dr. Walsh successfully secured a salary support
award from the KRESCENT program of the Kidney
Foundation of Canada this year.
Major Achievements
•
•
•
•
Recruitment of Dr. Jeff Dickhout, a CIHRfunded
PhD with an interest in ER stress
and progressive kidney disease.
Recruitment of Dr Karen To, with a focus in
peritoneal dialysis catheter insertion and
end-stage renal disease care.
Continued success in both funding and
publication in HCKR, fostering of research
in prostate cancer and in uremic vasculopathy.
Ongoing remarkable activity in the clinical
renal transplant program under the
Directorship of Dr. David Russell, with
around 100 transplants being routinely
performed on a yearly basis and over 1000
•
successfully transplanted patients now followed
in the program.
Leading edge innovations in educational
initiatives, particularly for residents in
the internal medicine program rotating
through nephrology.
Future Directions
The Division intends to consolidate its successes
in basic science research, maintaining a focus on
the securing of peer-reviewed funding. The clinical
research program is expected to grow, with the
efforts of Dr. Walsh and the anticipated recruitment
of Dr. Ribic in 2013. We will focus strongly
on educational innovation, and expect to continue
to lead the Department in this regard. The Division
is recognized for the excellence of its clinical care,
both dialysis and transplantation, and of course
that remains our guiding and driving principle.

100
REPORTS: DIVISION DIRECTORS
Dr. John Turnbull
BSc, MSc, MD, PhD, FRCPC
Division Director
Neurology
We anticipate that our stroke program will continue to grow,
we hope into one of the strongest in the country.
Educational Activities
Dr. Oczkowski continues as co-chair of the neuroscience
sub-unit for undergraduate medicine,
and most members participate in clinical skills
activities for medical students. Dr. Rathbone
continues to offer his popular neurology ‘boot
camp’ for medical students. At the post-graduate
level, Dr. Yegappan continues as program
director of the neurology residency program.
Drs. Paulseth, Rathbone, and Goodwin, continue
as site coordinators. The committee has representation
from adult neurosurgery (Dr. Reddy),
pediatric neurology (Dr. Cowan) and community
practice (Dr. Lad). In spite of significant strengths,
several deficiencies were noted in a recent RCPSC
review, which we believe have now been rectified.
Our first graduating resident, Dr. Picard, has
joined the group, based in part-time practice at
the Juravinski. Our second resident, Dr. Brian
Van Adel, is finishing a two-year fellowship in
interventional neurology in London, and we hope
that he will return to Hamilton afterwards to join
the neurovascular group. Dr. Silva coordinates
the neuroscience rounds at the HGH, and Dr.
Goodwin again coordinated the annual regional
CME program in neuromuscular diseases. Dr.
Kronby has been instrumental in raising funds for
the residency program. Drs. Rathbone, Mazurek,
Turnbull and Tarnopolsky are all involved in grad-
uate education. The Division has accepted several
clinical fellows for training.
Research Activities
Dr. Rathbone leads the CIHR-funded neuro-restorative
group, with particular interest in the trophic
role of purinergic compounds. Dr. Sahlas has
several funded studies in stroke. Dr. Tarnopolsky
remains prolific in neuromuscular research,
as does Dr. Baker. Dr. Mazurek continues his
research in neuropsychiatry, and Dr. Turnbull continues
with clinical and basic research in motor
neuron disease. Dr. Upton remains near to realizing
his dream of commercializing the smart
pacemaker and the responsive brain stimulator,
as well as a portable magnetic stimulation device
for the self-treatment of migraine, and continues
his collaboration with Dr. Robert Fischell
of Baltimore, and his son Dr. David Fischell. Dr.
McComas continues his research in neuromuscular
mechanisms and the use of transcranial
stimulation in migraine. Dr. Brown continues
with international research in rate-dependent
block in ALS patients. Dr. Gilani continues his
research interest in chronic pain, particularly as
related to peripheral neuropathies. Drs. Morillo
and Jichici are collaborating with other Canadian
groups, particularly with Dr. Bryan Young in
London, developing a research program to assess
the effectiveness of continuous EEG monitoring
in ICU patients. We are delighted that Dr. Robert
Hart will be joining our group very soon, bringing
a large enhancement to our stroke research.
Clinical Activities
Drs. Hart, Oczkowski, Silva, Sahlas, Yegappan,
and Jichici are involved in the acute stroke program
at the Hamilton General Hospital, which is
now the most active in the province in terms of
numbers. Dr. Yegappan also works in stroke at
St. Joseph’s Hospital. Dr. Giammarco continues
her complex headache clinic. Neuromuscular
activities and ALS have been greatly expanded,
and Drs. Tarnopolsky, Baker, Brown, Goodwin,
and Turnbull are involved. Dr. Jichici continues to
provide neurocritical care expertise, and gradu-
ates from our neurology residency will now have
the option of applying to a two-year fellowship in
neurocritical care. Dr. Shapiro has joined us after
completing a two-year fellowship in epilepsy in
Boston (Harvard), and is working with Dr. Morillo
to further develop regional epilepsy. Dr. Mazurek
is receiving wide recognition for his work in postconcussive
states and migraine.
Future Directions
We anticipate that our stroke program will continue
to grow, we hope into one of the strongest
in the country. The HHS has committed to supporting
two stroke fellows per year, and with this,
we expect to be able to recruit from within. We
are anticipating recruiting a neuro-oncologist to
the Juravinski site next year, and a movement disorders
specialist.

102
REPORTS: DIVISION DIRECTORS
Physical
Medicine
and Rehabilitation
The Department provides the full spectrum of rehabilitation services
for patients with general and specialized rehabilitation needs.
Faculty
Dr. Shanker Nesathurai
MD MPH FRCPC
Division Director
Dr. Shanker Nesathurai assumed the role of Chief
at HHS and SJH as well as Director of the Division
of PM&R. He succeeds Dr. David Harvey. Dr.
Harvey continues to serve as the medical director
of the Oncology Rehabilitation Program.
The Department welcomed Dr. Pawel Szapkowski,
Dr. Suneel Upadhye and Dr. Ada Dominguez, who
serve as Hospitalist on our in-patient units. Dr.
Andrew Graham has joined the department as a
research fellow.
On a sad note, Dr. Jane Gillett died this past year.
She led the acquired brain injury program, and
was a passionate advocate for people with neurological
diseases.
Education
Dr. Peter Varey continues as our Residency
Program Director. As in previous years, the
Department was successful in recruiting outstanding
residents via the CaRMS match. The
McMaster program is the second largest PM&R
Residency Program in Canada. Dr. Tania Henriques
and Dr. Anna Labuda graduated from the residency
program in 2011; both were successful in
obtaining certification from the Royal College of
Physicians and Surgeons.
Dr. Sharon Grad was recognized for her outstanding
contributions to teaching with the Department
of Medicine Teaching Award. Dr. Leo Farrauto
provides a liaison between our division and the
medical school.
Research
Dr. Mark Tarnopolsky and Dr. Steve Baker continue
to be the leading researchers in neuromuscular
rehabilitation in the country, with tremendous
innovation and groundbreaking research in
peripheral nerve and neuromuscular disorders.
Dr. Dinesh Kumbhare continues to be active in
MSK research at St. Joseph’s Healthcare. The main
theme of research is the development of measurement
methods for musculoskeletal injuries.
Drs. David Harvey, Kevin Letcher and Leo Farrauto
continue to develop research related to inpatient
rehabilitation outcomes in patients with cancer
and following orthopedic surgery. Drs. Nesathurai
and Graham continue with their research in spinal
cord injury.
Future Directions
The Department is actively recruiting new faculty
to support inpatient and outpatient programs.
Although the Department is one of the largest
academic programs in North America, there are
still many unmet clinical needs in the medical
schools catchment area. The Department is also
working to develop a comprehensive spasticity
management center.
Clinical Programs
The Department provides the full spectrum of
rehabilitation services for patients with general
and specialized rehabilitation needs. Of particular
note, the integrated stroke unit was opened in this
past year. This program provides seamless care
for patients with stroke from the time of initial
hospitalization to community discharge.

104
REPORTS: DIVISION DIRECTORS
Educational Activities
Members of the Division of Respirology are
involved in planning, tutoring, clinical skills preceptorship
and lecturing in the Undergraduate
Medical Program. The Respirology Residency
Training Program, under the leadership of Dr. Lori
N. Whitehead, has been very successful. During
her tenure the program has become highly
sought after by trainees interested in Respiratory
Medicine. She has been recognized by her peers
and elected to leadership roles in resident education
at the provincial and national levels.
Trainees from Internal Medicine, Anesthesia,
Radiation Oncology, Head and Neck Surgery, and
other postgraduate programs apply for rotations
in Respirology. The Respirology groups at the
Juravinski Hospital, Hamilton General Hospital,
and St. Joseph’s Healthcare Hamilton (SJHH) have
provided these training opportunities. The capacity
of the system is however over-subscribed,
which indicates the popularity of the Respirology
training experience among students and residents
and reflects the commitment to education among
our faculty.
Members of the Division are involved in graduate
and non-MD postgraduate education. Several
members supervise both MSc and PhD graduate
Dr. Gerard Cox
MB, FRCP(C), FRCP(I)
Division Director
Respirology
Many research activities are carried on in collaboration
with investigators in other Divisions.
students. Two very successful graduate courses
are organized: Pulmonary Physiology by Dr. Mark
Inman and Pathophysiology of Lung Diseases by
Drs. Gail Gauvreau and Roma Sehmi. One feature
that graduate students find very attractive
is the contribution to these courses by clinical
faculty, which provides context to the basic science
and mechanisms of disease that they learn.
Members of the Division frequently contribute
to Continuing Medical Education programs. Dr.
Mark Soth is chair of the Ontario Thoracic Society
committee responsible for organizing the annual
Better Breathing Conference.
Research Programs
Some of the major research interests of faculty
are the epidemiology, pathophysiology and treatment
of asthma; the physiology and pathophysiology
of airway and vascular smooth muscle;
the cellular and molecular biology of pulmonary
inflammation; controlled trials of therapy in respiratory
disorders, and the impact of the environment
on respiratory health. Professor Malcolm
Sears and colleagues direct the CHILD Study – a
longitudinal evaluation of a cohort of children at
four centres across Canada - with major funding
from the AllerGen network and recently renewed
support from the CIHR. Dr. Martin Stampfli
examines the early cellular responses to cigarette
smoke, with renewed CIHR grant support.
Through collaboration with Drs. Nair and Cox at
the FIRH-SJHH, he can examine the clinical correlates
of his findings in the basic science arena. Dr.
Mark Larche received considerable attention for
his work on determinants of allergy and how to
prevent development of common allergies. There
is ongoing interest in the use of personal handheld
devices (e.g. Blackberry) to obtain information
from patients on a daily basis. Neil Johnson
and Dr. Andrew McIvor used this technology in
a study of patients with COPD and Dr. Martin
Kolb will use it to evaluate how patients with
lung fibrosis experience their condition. Many
research activities are carried on in collaboration
with investigators in other Divisions - Allergy and
Immunology, Microbiology, Gastroenterology,
Rheumatology; and Departments – Thoracic
Surgery, Pathology, Pediatrics; within the Faculty
of Health Sciences.
Milestones and Awards
We mourn the passing of Dr. Frederick Hargreave,
one of the longest standing members of our
Division, who died suddenly in June 2011. Freddy
was admired and respected widely for the quality
of his clinical and his research work, and for
his humanity that characterized everything he
did. Part of his legacy is the laboratory at SJHH
developed for evaluating lung inflammation noninvasively.
This is a unique resource that provides
key support for clinical and research activities
and it is certain that other centres will seek to
develop similar facilities drawing on the advice of
those who worked with Dr. Hargreave. Drs. Helen
Neighbour and Param Nair will continue the clinical
care of patients with severe asthma.
Our membership continues to make important
contributions outside Hamilton. Dr. Helen
Ramsdale serves in the important role of Chair of
the Respiratory Section of the OMA. She is also
completing her term as an examiner in respirology
for the Royal College. Dr. Gerard Cox continues
as a member of the Steering Committee and
of the Executive Committee of the Lung Health
Framework, which is a national organization with
a broad mandate to advance respiratory health
in Canada.
Future Directions
The Division has developed strong ties with the
Division of Thoracic Surgery and the shared activities
will expand further to enhance the care of
patients with lung cancer. The technique of endobronchial
ultrasound guided transbronchial needle
biopsy was established jointly and it is expected
to change practice for the diagnosis of mediastinal
abnormalities. The Diagnostic Assessment
Program for lung cancer has rapidly become
very busy and effective. Next is the challenge
to provide care for patients with pleural disease
and expert follow-up for patients with nodules of
undetermined etiology through the establishment
of inter-disciplinary out-patient clinics.
There is a need for a multi-centre network of
expert investigators interested in severe asthma.
This group would advance science through collaborative
research and care through rapid translation
of findings to the patients with the most
troublesome disease. The Hamilton group will
help establishment this network.

106
REPORTS: DIVISION DIRECTORS
Dr. Alfred Cividino
BASc, MD, FRCPC, FACR
Division Director
Rheumatology
Our mission is to provide exemplary care for our patients,
foster excellence in education and research, create and disseminate
new knowledge.
Educational Activities
Dr. Rick Adachi has recently completed 17 years
as division director. In that role he has brought
together a dedicated group of clinicians, educators
and researchers. He has been a worldwide
ambassador for the Division while educating the
world about his passion, osteoporosis, and metabolic
bone disease. The Division greatly appreciates
the energy, insight and integrity he brought
to the role.
Educational Activities
The Division of Rheumatology is active in the
undergraduate educational program. Our focus on
patients has contributed to our success. Clinical
skills, interactive large group sessions, the patient
partners program headed by Dr. Tulio Scocchia
and our elective, “Rheumatology Boot Camp”
under Dr. Mark Matsos play important roles in
our educational endeavours. Dr. Raj Carmona has
taken the lead as planner for the MSK sub-unit of
Medical Foundations Five.
Under Dr. Nader Khalidi, the rheumatology training
program has flourished. Our most recent
trainees, Drs. Famorca, Mulgund and Clements-
Baker have received their sub-specialty designation
from the Royal College. All of our clinical faculty
have energetically participated in our teach-
ing activities with special thanks to Drs. Boulos,
Pavlova and Kaminska.
Research Programs
We have received major peer-reviewed and corporate
funding in our areas of research.
•
•
•
•
Dr. Famorca will join the Division as a
Clinical Scholar in July 2011. She is pursuing
additional training in vasculitis with
Dr. Khalidi in Hamilton and Dr. Carette in
Toronto. A major focus for Dr. Famorca is
developing Canadian Guidelines for diagnosis
and treatment of vasculitis.
Dr. Bensen continues to develop Bone
Destiny, a program that helps physicians
determine osteoporosis treatment. He is
also moving forward with his novel clinician
friendly clinical evaluation of patients
with RA.
Non-invasive imaging remains a cornerstone
of our research and utilizes pQCT
ultrasound and pMRI for the measurement
of bone mass, joint and cartilage structure.
Dr. Webber, Dr. Inglis and Dr. Gordon have
advanced our imaging capabilities.
Dr. Khalidi is working with two
major research groups, the Canadian
•
•
•
•
•
Scleroderma Research Group and the
Vasculitis Clinical Research Consortium.
Dr. Larche has been on leave for the past
year with the anticipation of returning to
the division in January 2012.
Dr. Cividino and Dr. Beattie have continued
their work with GALS and have moved
forward with their CIORA grant evaluating
GALS. This work has validated the screening
exam for diagnosing Rheumatoid
Arthritis in the hands of physiotherapists,
nurses and primary care physicians.
Dr. Beattie has recently received a
CIHR grant for her work ‘Bone Health
Implementing FRAX in primary care’.
Dr. Adachi, with members of the Division
of Rheumatology, has been measuring the
impact of MRI in RA with his CIORA grant.
Dr. Adachi has been principal or coinvestigator
on five CIHR grants totalling
$1,682,152.
Major Achievements
•
•
•
•
Dr. Cividino is the inaugural Abbott Chair
in Education in Rheumatology, presented
in June. He continues to develop
innovative educational opportunities with
his colleagues.
Dr. Karen Beattie has received a
Department of Medicine Career Award
for her work in osteoporosis and osteoarthritis.
This has led to obtaining a $95,491
CIHR grant. In addition Dr. Beattie is the
recipient of the Arthritis Society/Canadian
Arthritis Network Scholar Award as well as
a Personal Career Award.
Dr. Khalidi continues with his Clinician-
Teacher Award from the Arthritis Society
based on his excellence in transforming
the Rheumatology Residency Training
Program into the premier rheumatology
training program in Canada.
Dr. Larche received a Department of
Medicine career award. She helped to set
up the multi-divisional systemic sclerosis
research group, which she Chairs. Dr.
Larche has been instrumental in setting up
a “Centre of Imaging Excellence” funded
by Abbott.
•
•
Dr. Raj Carmona has completed an
excellent video series on musculoskeletal
examination. This will be a valuable
resource for the undergraduate and postgraduate
programs. Dr. Kim Legault, a
rheumatology trainee, participated in
this undertaking.
Dr. Matsos has been awarded an AFP
Internal Career Clinician Education Award.
Future Directions
The Division has collectively developed a consensus
document in the form of a strategic plan to
lay out the current and proposed activities for the
next three to five years.
Our vision is to be recognized for leadership and
innovation in education, research and Inter-disciplinary
patient-centered care.
Our mission is to provide exemplary care for
our patients, foster excellence in education and
research, create and disseminate new knowledge.
Our divisional goals are:
1.
2.
3.
4.
5.
To provide exemplary care for patients
with rheumatic diseases.
To pursue the investigation of the causes
and treatments of rheumatic diseases.
To widely educate our patients, the public,
students and colleagues on the nature of
rheumatic diseases.
To work collegially within the Faculty and
Department of Medicine in the promotion
of our common academic goals.
To advocate effectively for our profession
and for our patients.
Osteoarthritis, osteoporosis and rheumatoid
arthritis research will continue be our focus in the
coming years with further clinical and research
expertise being developed in systemic sclerosis
and vasculitis. We will continue with our expertise
in non-invasive imaging, examining cartilage
thickness, bone microarchitecture, edema and
erosions in rheumatoid arthritis using basic xrays,
ultrasound, pQCT and pMRI.
As director of the Division of Rheumatology, I am
excited by our strategic plan, and together with
my esteemed colleagues and excellent trainees,
anticipate execution of several objectives to meet
our main goals of exemplary patient care, education
and ongoing research.