VOLUME 4 ♦ I SS UE 2 ♦ FA LL 2004

The Bear Bones Universi ty of Bri t ish Columbia ♦ Department o f Family Practice ♦ Research Newsletter

Inside this Issue:

Division of Midwifery 2

NEW! International Health Division

3

CIHR NET, Tri-Agency 4

Grants 5

Publications 6

Upcoming Conferences & Workshops

8

Dr. Morgan Price 9

Interview with Resident 10

Dr. Gina Ogilvie 11

Budget Tips for Research Grants

12

June 18, 2004 was an exciting day of research presentations and awards including the Peter Grantham, Postgraduate Teaching Awards, graduation certificates , BC College of Family Physician prizes, Lloyd Jones Collins Awards and John J. Zack Prize in Family Medicine.

Dr. Rob Wedel, an honoured guest, and the President of the CFPC, read out the declaration of commitment that was signed June 17, 2004 on behalf of all members. He said “Our commitment emphasizes the most important thing that we do, and that is commit to building a strong patient-physician relationship. It was very important to those doctors fifty years ago and that hasn't changed, it's the same today.” Declaration of Commitment The Declaration outlines values and

principles. As family physicians and members of the College of Family Physicians in Canada, we value: ■ the privilege of being personal

physicians for the individuals and families who are our patients

■ the trust placed in us by our patients, our peers and our communities

■ the role we play in meeting the changing needs of the health system of the people of Canada

■ the importance of our college motto: in study lies our strength which inspires us to maintain the highest standards of practice, teaching, research and life long learning

As family physicians who care for patients, teach students and conduct research we are

(Continued on page 12)

2004 RESIDENTS’ RESEARCH DAY FAMILY MEDICINE CELEBRATES 50 YEARS IN CANADA

Postgraduate Teaching Award Winners Greater Vancouver: Penny Miller, Ian Scott Chilliwack: Hugh Mitenko, Kon Son Prince George: Khalid Bashir, Steven Chang Rural: Sebouh Matossian, Gerald McFetridge St. Paul’s Hospital: Ernie Murakami, Morgan Price Victoria: Amanda Barclay, Alex Dougall, Rai Pai. John J. Zack Prize: Cindy Orlaw

Mission Statement

The mission of the University of British Columbia

Department of Family Practice is the education of physicians who are effective providers of family-

centred health care. This mission includes the

stimulation and facilitation of academic and community-based

research and education.

The Division of Midwifery by Elaine Carty, Director

In the fall of 2000 the Ministry of Ad-vanced Education Training and Tech-nology (MAETT), invited the Univer-sity of British Columbia to develop and provide a university based midwifery education program to prepare students for entry to the Register of Midwives with the College of Midwives of British Columbia.

During the time that the program pro-posal was being developed, it was nec-essary to determine an academic home for the program. Dr. Robert Woollard kindly extended an invitation for the midwifery program to be housed in the Department of Family Practice as the Division of Midwifery. This seemed like an ideal location from both practical and intellectual perspectives given the focus of normal birth for both family physicians and midwives.

In March 2001 the program proposal was reviewed and approved by the Fac-ulty of Medicine Curriculum Commit-tee. In April, the Faculty Caucus of the Faculty of Medicine approved the pro-gram. In May of 2001, the University Senate approved the program and Feb-ruary 2002 funding approval was granted by the Ministry of Advanced Education.

The new program was publicly an-nounced in February 2002. Approxi-mately 80 applications were received by April 30 for consideration for the first intake of students. Because so many students had been doing preparatory work for admission to an eventual pro-gram, a decision was made to admit 10 students to the second year of the pro-gram as well as 10 students to the first year. The Division currently receives 100 applications for an intake of 10 stu-dents per year. The first students will graduate in May 2005 with a Bachelor

of Midwifery (BMW).

The curriculum is designed to graduate entry level midwives who meet the competencies required of the College of Midwives of British Columbia (CMBC) and who practice under the regulations of the CMBC using the philosophy of midwifery as outlined by the CMBC, as well as the College’s code of ethics and clinical guidelines.

The program’s mission statement is:

To prepare midwives who are able to provide effective and appropriate mid-wifery care as a full member of the primary care system. These midwives will be fully educated so as to be skilled, personally sensitive and able to reason and use a broad base of knowl-edge in order to improve the health of individuals, families, and populations, around the time of birth.

Arts and Science courses constitute ap-proximately 30% of the 4-year curricu-lum with Midwifery non-clinical courses making up an additional 10% of the curriculum. Clinical courses consti-tute 60% of the curriculum.

The curriculum is organized to provide pre-clinical foundational courses in the first three terms. Beginning in the third term students complete a sequence of courses and clinical placements that develops their knowledge and skills in the areas of prenatal, labour and birth, postpartum and newborn care. The em-phasis is on “normal” childbearing in the early courses with variations on normal and complications being inte-grated in later courses. The final course is a clerkship where students have greater independence and carry a work-load similar to that of a full time mid-wife.

We currently have two full-time faculty, two part-time faculty and three ses-sional instructors. Research Activities Dr. Eileen Hutton has received both a Michael Smith Career Scientist Award and a CIHR New Investigator Award to carry out her research program. She has

CIHR funding of 2.8 million dollars to carry out a 25 country randomized con-trolled trial of early external version and its influence on rate of Caesarean section. Dr. Hutton is a co-investigator with the team from Sunnybrook and Women’s College Health Sciences Cen-tre in Toronto on a RCT of the appropri-ate delivery method of twins. In addi-tion, she is working with Dr. Jude Kor-nelsen from the Department of Family Practice on women’s attitudes toward patient-initiated elective cesarean sec-tion. Both Dr. Kornelsen and Dr. Hutton are co-editors of the first refe-reed midwifery journal in Canada, the Canadian Journal of Midwifery Re-search and Practice. This journal is partly funded by SSHRC.

Elizabeth Ryan is a part-time faculty member and she has been a co-investigator with the Home Birth Dem-onstration Project which assessed the outcomes of midwife attended home births in British Columbia. She has been the co-author of two papers pub-lished out of this work. She is currently examining midwifery care and vaginal birth after caesarean outcomes(VBAC).

Cathy Ellis has recently joined our fac-ulty. She comes from Saskatchewan where she has been involved with a project involving youth sex trade workers in Regina. Cathy has done many international projects around maternal and child health and mid-wifery. She has taught local midwives in Mexico and Nicaragua and Kosovo.

Elaine Carty has been a co-investigator on Dr. Patti Janssen’s CIHR funded trial of the effect of early labour sup-port at home and is part of the evalua-tion team for the South Health Com-munity Birth Program. She also works with Patricia Peppin from Queen’s Law School using semiotic theory to ana-lyze pharmaceutical advertisements with respect to issues of gender, race and disability. Elaine supervises doc-toral and master’s thesis in the School of Nursing. Elaine Carty is Professor and Director of the Division of Midwifery

PAGE 2 THE BEAR BONES VOLUME 4 ISSUE 2

About eight years ago the UBC Depart-ment of Family Practice recognized and began to address a very poor standard of health in the inner cities of Vancou-ver and other urban centres in BC. Today the battle against the impover-ishment of marginalized populations in Vancouver is far from over, however, through the development of the Divi-sion of Inner City Health and CHIUS (Community Health Initiative for Uni-versity Students), the Department of Family Practice has solidified a continu-ally growing effort to lessen the suffer-ing in our cities core. With projects in the home front firmly established, Dr Peter Granger, and many senior stu-dents and recent graduates have ex-tended their vision to comparably poorer standards of living in other countries, where struggling health care systems are inadequate to meet the population's most basic medical needs. The proposal for a Division of Interna-tional Health within the Department of Family Practice has been a combined ef-fort of undergraduate and graduate stu-dents and has received overwhelming support. Through consultation with a number of students and graduates with experience in international health, the need emerged for faculty support and structure. This September Dr. Peter Granger and Dr. Peter Kirk presented the Department with a proposal for a Division of International Health. Dr. Kirk of Victoria has agreed to serve as the director of this new Division. He

has had considerable experience in this field. Dr. Bob Woollard, as chair of the Department of Family Practice has of-fered his support, and Dr Jerry Spiegel, Director of the Centre for Interna-tional Health, is enthusiastic about the progress made so far. The proposed initiatives for a Division of International Health are multifold. The Division would create a structure of support for international health work and develop curriculum, advo-cacy and research in the undergradu-ate and postgraduate programs. The goals of the Division are: ■ To support students, residents, and

faculty interested in international health work through access to essen-tial information and skills develop-ment in international health. This would be accomplished through practical exposure to and experience in international health projects in re-source poor countries. The depart-ment would provide medical stu-dents and residents with support in related electives and research pro-jects through experienced mentors, advisors, supervisors and access to funding opportunities;

■ To work collaboratively with the Centre for International Health and other Faculties and Schools, particu-larly in the health sciences and hu-man sciences, to foster an inter-professional approach in the provi-sion of service to developing coun-tries relevant for our future physi-cians;

■ To assist in the development of health research within the host country either by participating in specific projects or by the mentoring of proposals originating in the host country;

■ To assist in the coordination of differ-ent international initiatives to avoid duplication of effort and to that end initiate an inventory of interna-tional initiative in the faculty and in outside organizations.

Fundamentally, the success of this divi-

sion will depend upon student, resident and faculty commitment. Sometimes there is a progression from the enthusi-astic student through to the jaded resi-dent. It is hoped that by working in re-source poor countries, enthusiasm for medicine will be enhanced when vol-unteers see that their work has had a very definite and tangible benefit not only in the short term but possibly even an impact on social policy within the host country. Dr. Donald Berwick in a recent paper in the BMJ reminds us of the rewards of working in developing countries (BMJ2004;328:1124-1129): “My work in these settings has convinced me not only that it is possible to improve health care in resource poor settings but also that improvement may even be more feasible than it is in wealthy ones. Projects in progress in the devel-oping world show the tremendous re-sourcefulness, innovation, and potential for improvement in that resource con-strained context, with potentially im-portant lessons for caregivers in richer places.”

Those who launched this project envi-sion a collaborative effort between an NGO such as Doctors without Borders and the Division of International Health that would send teams of volun-teers into the field to fight, among other things, the HIV/AIDS epidemic. Ac-cording to the UBC principles of inter-nationalization, “the university is part of a network of learning that stretches around the world, and in an increas-ingly global environment it encour-ages the development of teaching, learning, and research intended to strengthen British Columbia's and Canada's links to other nations”. Through creation of a structure of sup-port for international health work and development of the curriculum within the Faculty of Medicine, UBC will con-tinue to uphold its longstanding tradi-tion as a progressive force in interna-tional development. Trek 2000: UBC’s Vision. Nov. 1998 www.trek2000.ubc.ca/principles/internationalization.html Dr. Peter Granger (Director, Div. of Inner City Medicine), Dr Peter Kirk (Director, Div. of In-ternational Health), Sean Nixon (Research As-sist., Div. of Inner City Medicine)

Dr. Peter Kirk, Director

PAGE 3 THE BEAR BONES VOLUME 4 ISSUE 2

INTERNATIONAL HEALTH A New Division in the Dept. of Family Practice

Two of the rural women who shared their experiences to inform the study "Rural

Women's Experiences of Maternity Care"

Our program of research entitled Responding to Rural Communities: Building a Program of Research in Rural Maternity Care, was recently funded by a CIHR New Emerging Team (NET) Grant.

This program of research is based on two previous studies entitled Rural Women's Experiences of Maternity Care (funded by CIHR) and Rural Women's Experiences of Maternity Care: Implications for Policy and Practice (funded by Status of Women Canada).

Our recent activities have included revisiting the communities that were involved in these previous studies, both to report what we learned and to discuss what further research needs to be done.

In September we reported back our research findings to research participants and other interested community and health services audiences in Bella Bella, Alert

Bay, Port McNeill, Port Hardy and Tofino. In November, we travelled to Haida Gwaii/Queen Charlotte Islands to share what we have learned with interested community members and care providers in Masset, Queen Charlotte City and Skidegate.

This process of continued engagement with research participants has helped us to ensure that our research remains relevant to rural women, care providers and communities, and that we continue to learn in our relationships with them. Our visits are also important opportunities to gain the ideas and insights of rural women and their families, maternity care providers and health service administrators as we move forward. We are committed to working with rural communities so that their unique needs are recognized and supported through a shared research agenda.

■ Proper use of funds ■ Integrity in research ■ Common challenges. The Tri-Agency Financial Administration Guidelines are at: www.nserc.gc.ca/professors_e.asp?nav=profnav&lbi=toc_fin Examples of Tri-Agency ineligible costs are: ■ Telephone/fax rental and

installation, pagers, cells ■ Membership dues and

The audit team were on campus the week of September 14, 2004 on a monitoring visit at Financial Services and conducting interviews with researchers across campus. An information session entitled “Using Your Funds” was presented for researchers, administrative staff and other personnel. Highlights were: ■ Financial Accountability ■ Responsibilities of the

researcher, institution and the agency

tuition costs ■ Insurance of any type

(equipment, vehicle) ■ Alcohol ■ Business class travel

If in doubt about claiming a a cost, obtain advance ruling from Tri-Agency and keep the documentation.

20% is given to UBC to cover costs that the Tri-Agency considers as overhead.

CIHR New Emerging Team Visiting Rural Communities - Research in Rural Maternity Care

CIHR, NSERC & SSHRC Tri-Agency

PAGE 4 THE BEAR BONES VOLUME 4 ISSUE 2

Granting Agency Subject $ /Yr Year Investigator(s)

CIHR, University-Industry Program

A Safety and Efficacy trial of activated protein C for pre-eclampsia

98,824 2004-07 P. von Dadleson, L Magee, S. Lee, B. Carleton, A. Skoll, S. Young, P. Janssen et al.

CIHR, Institute of Human Development, Child and Youth Health

Antepartum Home Care: Time for a Trial? 3,700 2004 P. Janssen, L. Palmer

Canadian Foundation for Innovation

Centre for Hip Health: A Lifespan Approach 3,850,000 2004/09 T. Oxland, C. Duncan, J. Esdaile, M Fitzgerald, K.Khan, ....et al., P. Janssen

Peter Wall Institute Theme Development Grant 400 2003 P. Janssen

Michael Smith Foundation Research Unit Infrastructure Award

Musculoskeletal Research Centre: New Coordinated Applications for Bone Health

150,000 2003-06 T. Oxland, K.Khan, H. Mckay, P. Janssen et al.

Michael Smith Foundation Research Unit Infrastructure Award

Centre for Healthcare Innovation and Improvement (Qualified Health Researcher)

150,000 2003/07 S.Lee , L. Magee, M. Ansermino, P. Janssen, R. Liston, Y MacNab et al.

Vancouver Coastal Health Authority, Improving Outcomes Initiative

The South Community Birth Program 180,000 2003/06 S. Harris, L. Saxell, P. Janssen

CIHR Interdisciplinary Women’s Reproductive Health Research Training Program

299,150 2003/09 P.Leung, Brown C, Janssen P, McFadden D, Ma, S Lim, K et al.

CIHR Development of Migration and Reproductive Health Studies

99,550 2003 A. Gagnon, Dougherty F, Janssen P, Oxman J, Saucier J, Stewart D, Wahoush O.

CIHR Emerging Teams Grant Northern Health Research Competition

268,602 2004/09 Grzybowski S, Kornelson JA, Klein MC, , Reid RC, Schuurman NC, Thommasen HV. Broemelling AM.

MSF Do hospital reduced (RAD) activity days independently predict a longer hospital length of stay among a cohort of pneumonia patients admitted to a large teaching hospital in Vancouver, British Columbia?

3,700

10,000

2004/05 McGregor MJ

Nelly Auersperg Award

Nike Global Research Foundation

3,000 06/2004 Taunton JE

BC Research Centre for Children’s & Women’s Health

Establishment Grant 100,000 2004 Klein, M.

SSHRC Department of Family Practice research grant

Systemic differences in costs for residents living in funded non-profit and for-profit long-term care

10,000 2004/05 McGregor MJ, M Cohen, Patricia Wejr, Hankivsky O CURA

Department of Family Practice Research grant

Comparing side effects of oral contraceptives in ethnic Chinese and Caucasian women

5,000 Wiebe, E.

CIHR Physical activity, mobility and health-related quality of life of community-living individuals with chronic disease

97,925

1,625

1 yr ENG, Janice J et al Miran-Karim Khan

CIHR Knowledge Translation for Chronic Disease Management in Primary Health Care Renewal in BC

25,000 2003/04 M. McLure, R. Woollard

Grants Awarded (June 2004 to November 2004) PAGE 5 THE BEAR BONES VOLUME 4 ISSUE 2

■ Larden C, Palmer L, Janssen, P. Efficacy of Therapeutic Touch in Treating Pregnant, Inpatients Who Have a Chemical Dependency, Journal of Holistic Nursing, in press.

■ Janssen P, Lee S. Outcomes of planned hospital vs. planned home births in British Columbia. Journal Salude (i) Cien-cia [Spanish], in press.

■ Ashe M, Khan KM, Kruse K, Hughes K, O’Brien PJ, Guy P, Janssen P, McKay H. Low-trauma fractures and osteopo-rosis: An early warning system. Journal of Hand Therapy, in press.

■ Mackelvie, K, Khan K, Petit, M, Janssen P, McKay H. A school-based exercise intervention elicits substantial bone health benefits: A 2-year randomized controlled trial in girls. Pediatrics 2003;112:447-452.

■ Thommasen HV, Anderson N, McArthur A, Tildesley H. Do Rural Diabetics Benefit From the Occasional Visit to an Urban Based Diabetic Education Centre? BCMJ Scheduled for November 2004

■ Thommasen HV. Reflections: One step forward, one step back. Can Fam Physician. 2004; 50: 1215. ■ Thommasen HV, Klein MC, MacKenzie T, Grzybowski S. Bella Coola General Hospital perinatal outcomes: 1941 to

2001. In Press Can J Rural Med ■ Thommasen HV, MacKenzie T, Klein MC, Lynch N, Reyes R, Grzybowski S. Bella Coola Hospital obstetric maternal

outcomes: 1941 to 2001. In Press Can J Rural Med ■ Thommasen HV, Tallio B, Barton S, Zhang W, Michalos AC. Health and Quality of Life of Residential school survi-

vors, Bella Coola Valley, 2001. Submitted to SIR 2004. Can be viewed via Kluwer Academic Publishers website. ■ Michalos AC, Thommasen HV, Anderson N, Zumbo B. Determinants of health and the quality of life in the Bella

Coola Valley. Accepted to SIR 2004. Can be viewed via Kluwer Academic Publishers website. ■ Thommasen HV, Michalos AC, Grzybowski S, Berkowitz J, Lavanchy M, Connelly I. Determinants of rural physician

quality of life. Social Indicators Research. 2004; 69: 93-101. ■ Thommasen HV, Thommasen CT, Martiquet P, Jin A. Causes of Death Among Status Indian and Other People Living in

the Bella Coola Valley Local Health Area (1987-2001). BC Medical Journal. 2004; 46(4): 179-187. ■ Thommasen HV. A Practical Application of Mixed Methods Research. Invited Commentary for: Ann Fam Med 2004; 2: 7-

12. www.annfammed.org/cgi/eletters/2/1/7. ■ Thommasen HV, Patenaude J, Anderson N, Mc Arthur A, Tildesley H. Differences in diabetic co-morbidity between

Aboriginal and non-Aboriginal people living in Bella Coola, Canada. Rural and Remote Health 4 (online), 2004: 319. ■ Martin RE, Hislop T.G., Grams G., Calam B., Jones E., Moravan V. Evaluation of a cervical cancer screening intervention

for prison inmates. Can J Public Health 2003;95(4):285-89. ■ Martin RE, *Gold F, *Murphy W, Remple V, Berkowitz J, Money D. Drug use and risk of bloodborne infections: a survey of

female prisoners in British Columbia. In press, Can J Public Health will publish in early 2005 ■ Stuart G, Taylor G, Bancej C, Beaulac J, Colgan T, Franco E, Kropp R, Lotocki R,Mai V, McLachlin M, Onysko J, Mar-

tin RE. Report of a 2003 Pan-Canadian Forum on Cervical Cancer Prevention and Control. In press SGOC, will publish Nov-Dec 2004.

■ Elliott JA, Jamieson JL, Donelly ML, Malone M. , Measurement Properties of a New Falls Risk Self-Assessment: Ques-tionnaire for Seniors, Geriatr Today: J Can Geriatr Soc 2004;7:98-102.

■ Harris, Susan J., Saxell, Lee. Collaborative Maternity Care: The South Community Birth Program. Canadian Journal of Midwifery Research and Practice, Vol.2, Issue 3, Winter 2003-4.

■ Ashe M, Khan K, Guy P, Kruse K, Hughes K, O’Brien PJ, Janssen P, McKay H. Wristwatch-distal radial fracture as a marker for osteoporosis investigation: controlled trial of patient education and a physician alerting system. Journal of Hand Therapy, 2004;17(3):324-8.

■ Liu-Ambrose T, Khan K, Janssen P, Lord S, McKay H. Resistance training and agility training improve fall risk in 75-85 yr old women with low bone mass: A 6-month RCT. Journal of the American Geriatrics Society 2004;52(5):657-65.

■ Janssen P, Lee S. Outcomes of planned hospital vs. planned home births in British Columbia. Journal Salud (i) Cien-cia [Spanish] 2004;12 (5) 19-21.

■ Hogel K.L., Hutton E.K., McBrien K.A. Barrett J.F.R. Hannah M.E. Caesarean Delivery for Twins: a systematic review and meta-analysis. Am J Obstet Gynecol 2003; 188:220-7.

■ MC Ashe KM Khan PA Janssen P Guy HA McKay SR Majumdar. WristWatch: Improving Osteoporosis Manage-ment in "At Risk" Fracture Clinic Patients. Osteoporosis International (accepted September 2004)

■ MM Sran KM Khan Q Zhu HA McKay TR Oxland. Failure Characteristics of the Thoracic Spine with a Posteroante-rior Load: Investigating the Safety of Spinal Mobilization. Spine (in press Nov 2004)

■ MC Ashe KM Khan P Guy PA Janssen HA McKay. BC physicians report barriers to investigating osteoporosis after fragility fractures: Why does the gap in care persist? BC Medical Association Journal (in press December 2004)

(Continued on page 7)

Publications, April 2004 to date (plus previously unreported) PAGE 6 THE BEAR BONES VOLUME 4 ISSUE 2

Publications cont’d

PAGE 7 THE BEAR BONES VOLUME 4 ISSUE 2

■ Du Mont J, McGregor MJ. Sexual assault in the lives of urban sex workers: a descriptive and comparative analysis. Women & Health 2004;39(3):79-96.

■ McGregor MJ, Ericksen J, Ronald LA, Janssen PA, Van Vliet A. Schulzer M. Rising Incidence of Drug-Facilitated Sex-ual Assault in Vancouver, British Columbia. Accepted for publication, Canadian Journal of Public Health, to be pub-lished in Nov/Dec, 2004 or Jan/February, 2005.

■ Harris SJ, Farren MD, Janssen PA, Klein MC, Lee SK. Single room maternity care: Perinatal outcomes, economic costs, and physician preferences. JOGC. 2004; 26 (4): 633-40.

■ Klein MC, Kelly A, Kaczorowski J, Grzybowski S. The effect of family physician timing of maternal admission on procedures in labour and maternal and infant morbidity. JOGC. 2004: 26 (4): 641-5.

■ Martel MJ, MacKinnon, Arsenault MY, Bartellas, E, Cargill YM, Daniels RN, Gleason T, Iglesias S, Klein MC, Roggen-sack A, Wilson AK. Guidelines for vaginal birth after previous caesarean birth. JOGC. 2004: 26 (4): 660-70.

■ Yarrow C, Benoit GA, Klein MC. Outcomes after vacuum-assisted deliveries: births attended by community family practitioners. Can Fam Physician 2004; 50: 1009-14.

■ Klein MC. Quick Fix Culture: The cesarean-section-on-demand debate. Guest editorial. Birth 2004;32(3): 161-4. ■ Reime B, Klein MC, Kelly A, Duxbury N, Liston R, Saxell L. Do Maternity Care Provider Groups Have Different Attitudes

toward Birth? BJOG: an International Journal of Obstetrics & Gynaecology., In Press. ■ Wiebe E, Guilbert E, Jacot F, Shannon C, Winikoff B. A fatal case of Clostridium sordellii septic shock syndrome asso-

ciated with medical abortion. Obstet Gynecol 2004. ■ Wiebe E, Trouton K. Comparing vaginal and buccal misoprostol when used after methotrexate for early abortion.

Contraception 2004. ■ Wiebe ER, Janssen PA, Henderson A, Fung I. Ethnic Chinese women's perceptions about condoms, withdrawal and

rhythm methods of birth control. Contraception 2004;69:493-6.20 ■ Wiebe ER, Trouton KJ, Fielding SL, Grant H, Henderson A. Comparing anxiety and attitudes to abortion in women

presenting for medical and surgical abortions. J Obstet Gynecol Can 2004 ■ Wiebe ER, Trouton KJ, Fielding SL, Klippenstein J, Henderson A. Anti-choice attitudes to abortion in women present-

ing for medical abortions. J Obstet Gynecol Can 2004 20 ■ Wiebe ER, Greiver M. Family Physicians' experiences with implementing Cognitive Behavioural Therapy in their

practice: a qualitative study. Can Fam Phys 2004. ■ Measurement Properties of a New Falls Risk Self-Assessment: Questionnaire for Seniors Elliott JA, Jamieson JL,

Donellly ML, Malone M. Geriatr Today: J Can Geriatr Soc 2004;7:98-102. ■ DB Clement, JE Taunton Extracorporeal shock wave therapy in the management of plantar fasciitis. BCMJ 2004;

40(4):174-178. ■ J Taunton MSc MD, T Fuchs BScPT, M Hungerford BScPT BHK, S Fraser BPT ■ Ogilvie GS, Knowles L, Taylor D, Tigchelaar J, Brunt C, James L, Wong E, Maginley J, Jones H, Rekart ML . Incorpo-

rating a Social Networking Approach (SNA) to Enhance Contact Tracing in a Heterosexual Outbreak of Syphilis. Sexu-ally Transmitted Infections (accepted)

■ Rekart ML, Wong T, Wong E, Hutchinson K, Ogilvie GS. The impact of syphilis mass treatment one-year later: self-reported behaviour change among participants. International Journal of STD and AIDS (accepted)

■ Ogilvie GS, Jones HD, Marchand R, Trussler T, Rekart ML. Infectious Syphilis Outbreak in British Columbia: a changing epidemic. BC Medical Journal, May 2004

■ MG Donaldson KM Khan JC Davis AE Salter M Bell J Buchanan D McKnight PA Janssen HA McKay. Emergency Department Fall-Related Presentations Do Not Trigger Fall Risk Assessment: A Gap in Care of High-risk Outpatient Fallers. Journal of General Internal Medicine (submitted June 2004)

■ HA McKay G Tsang A Heinonen K MacKelvie DJ Sanderson KM Khan. Ground reaction forces associated with an effective school-based jumping intervention in pre and early pubertal girls and boys. British Journal of Sports Medi-cine (submitted July 2004)

■ H Macdonald S Kontulainen K MacKelvie-O'Brien MA Petit PA Janssen KM Khan HA McKay. Maturity and sex-related changes in tibial bone geometry, strength and bone-muscle strength indices during growth: A 20-month pQCT study. Bone (submitted August 2004)

■ SG Burne C Mahoney BB Forster MS Koehle KM Khan. Tarsal navicular stress injury: Long-term outcome and clini-coradiological correlation using both CT and MR imaging. American Journal of Sports Medicine (submitted August 2004)

■ MM Sran KM Khan K Keiver J Chew HA McKay TR Oxland. Accuracy of DXA scanning of the thoracic spine: Ca-daveric studies comparing BMC, area BMD, and geometric estimates of volumetric BMD against ash weight and CT measures of bone volume. European Spine Journal (revision requested August 2004)

(Continued from page 6)

(Continued on page 8)

Publications cont’d

PAGE 8 THE BEAR BONES VOLUME 4 ISSUE 2

■ A Scott KM Khan J Heer JL Cook O Lian V Duronio. High strain mechanical loading rapidly induces tendon apopoto-sis: An ex-vivo rat tibialis anterior model. British Journal of Sports Medicine (submitted August 2004)

■ MM Sran KM Khan Q Zhu TR Oxland. Posteroanterior Stiffness Predicts Sagittal Plane Mid Thoracic Range of Motion and Three-dimensional Flexibility in Cadaveric Spine. Journal of Clinical Biomechanics 20040817 (submitted Septem-ber 2004)

■ Janssen P, Demorest L, Whynot E. Acupuncture for Treatment of Substance Use in the Downtown Eastside of Van-couver, Journal of Urban Health, in press.

■ Ashe M, Khan K, Janssen P, Guy P, McKay H. Improving osteoporosis management in “at risk” fracture clinic pa-tients. Journal of the American Geriatrics Society, in press.

■ Janssen P, Keen L, Soolsma J, Seymour L, Harris S, Klein M, Reime B. Perinatal Nursing Education for Single Room Maternity Care: An Evaluation of a Competency-based Model. Journal of Clinical Nursing 2004;13, in press

■ Janssen P, Nicholls T, Ravinesh K, Stefanakis H, Spidel A, Simpson E. Of Mice and Men: Will the intersection of social science and genetics create new approaches to intimate partner violence? Journal of Interpersonal Violence 2004;20; in press.

■ McGregor M, Ericksen J, Ronald L, Janssen P, Van Vliet A. Rising incidence of drug-facilitated sexual assault in Van-couver, British Columbia. Canadian Journal of Public Health, in press.

■ Dennis C, Janssen P, Singer J. Identifying Mothers at Risk for Postpartum Depression: Development of a Predictive Model in the Immediate Postpartum Period. Acta Psychiatrica Scandinavica, in press.

■ B. Wright, I. Scott, et al: Career choice of new medical students at three Canadian Universities: family medicine versus specialty medicine. CMAJ June 22, 2004 Vol. 170 No. 13

■ C. Yarrow, A. Glen Benoit, Michael C. Klein: Outcomes after vacuum-assisted deliveries. Births attended by com-munity family practitioners. Canadian Family Physician Aug 2004 CFPC

■ SJ. Harris, MD. Farren, PA. Janssen, MC. Klein et al: Single room maternity care: perinatal outcomes, economic costs, and physician preferences. JOGC Vol 26, No. 7

■ MC. Klein, A. Kelly, J. Kaczorowski, S. Grzybowski The Effect of Family Physician timing of maternal admission on procedures in labour and maternal and infant morbidity. JOGC Vol 26, No.7 July 2004

Books ■ Thommasen H, K. Hutchings, with W. Campbell and M. Hume. Birds of the Raincoast: Habits and Habitat. Harbour

Publishing. In press: 2004. ■ Ogilvie GS, Risdon CL. Finding a Place for Population Health in Primary Care: A Resource Manual for Family Medi-

cine Teachers. Hamilton: McMaster University, 1999. Chapters ■ Ogilvie GS, Yudin M. Management of Urethritis. Canadian STD Guidelines, 2004 (in press). ■ Wilson R and Ogilvie G. Pregnancy and Childbirth, in HIV Care: A Primer and Resource Guide for Family Physi-

cians. Editors. Tessier D, Dion H, Grossman DW, Rachlis A. Mississauga, Ont: College of Family Physicians of Can-ada; 2001

Scholarship Corneil T. Janus CME Scholarship. Strengthening Communities while reorienting health services & building healthy public policy: creating conditions for health. CFPC 2002-2004

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Upcoming Medical Conferences & Research Workshops ■ Fifth Western Departments of Family Medicine Research Meeting, Vancouver BC, May 6, 2005. Registration and

Abstract submission deadline is April 8, 2005. See www.familypractice.ubc.ca/indexb.html for more details. ■ 18th World Conference of Family Doctors, WONCA 2007, Singapore July 24-28, 2007. 15, 2004. See

www.wonca2007.com for more details. ■ 33nd NAPCRG Annual Meeting, October 15-18, 2005, Hilton Quebec, Quebec City. See www.naprcrg.org for more

details. The call for papers brochure will be available the beginning of January 2005 at which time the electronic sub-mission process will be open.

■ Family Medicine Forum 2005, Vancouver Convention & Exhibition Centre, December 9-11, 2005. See www.cfpc.ca for more details.

■ Work in Progress Rounds, UBC Department of Family Practice, held the 2nd Wednesday of every month. See www.familypractice.ubc.ca/indexb.html for more details.

Dr. Morgan Price

TBB: What is medical informatics? MP: It is basically information manage-ment in medicine. It is getting the right information to the right people at the right time. So if I'm making a decision about a patient, or a patient is making a decision about their own health, they should have the right piece of informa-tion at hand to aid them in that decision making. TBB: What area are you most interested in? MP: The area that I am most interested in is clinical decision support. If I need to make a decision about a patient, I want to know what I need to know about them right in front of me instead of buried away in a chart somewhere in another building. Right now we are working on point of care preventative care reminders. This is a way to remind me of the patient’s needs based on their personal conditions. If you look at the studies, people are only getting about 50% of what they should be getting as far as screening, so if we can improve that we can improve long term health.

TBB: What is EGADSS? MP: EGADSS stands for the “Evidence Based Guideline and Decision Support System". It is the tool we are develop-ing that will provide intelligent remind-ers to the physician or patient at the point of care through an Electronic Medical Record (EMR). This is an open source project that can be integrated

into an EMR platform. We are releasing this tool as a free, open source project in order to in-crease adoption by EMR ven-dors. This is an extension of prior work on decisions sup-port. The simplest version of this idea was my resident re-search project, Palm Prevention. It takes the patient’s information and then it gives back screening recommendations that are spe-cific to that patient all on a Palm PDA. EGADSS goes another step further in that it takes infor-

mation from the EMR and the user gets the feedback automatically.

TBB: Does this take away the doctor’s role? MP: Not at all. The doctor’s role is al-ways to contextualize information and work with the patient. The role of the doctor is to educate the patient about their health, if I can be aided in this, then I am doing a better job.

TBB: What do you see as the future for this project? MP: I think it's going to take a while, but I think medical informatics will change the work flow of medicine. Our work flow has not changed since the SOAP note was invented and yet medi-cal technology has blossomed and ex-ploded. We can't maintain our current system. We cannot work harder. We have to change. I think that tools like these are one aspect to improving the process. In the future, projects like EGADSS should help us look at our practices in new ways – we need to be able to see our practice and see where to improve and you cannot practically do that on paper.

TBB: How would you define decision sup-port? MP: I see decision support in three ar-eas: 1. Point of care: When I'm seeing pa-tients and I want to know how to treat that particular patient 2. Point of reflection: did I do a good job with my patient population?

3. Proactive care: What needs to be done tomorrow or next month, based on the medical evidence?

TBB: Where do you see yourself going in the next few years? MP: I'm going to keep working on this!! I think there is so much to learn about: How do we support doctors in making better decisions and how do we help provide safer, higher quality care.

TBB: Where else can you see this going? MP: The national research council is trying to incorporate EGADSS into per-sonal records, so that patients can have access to their own health record. We would also like to use informatics as a tool to locate patients who would be useful for studies. So with some minor modifications you can actually turn EGADSS into the back end of the re-search network.

TBB: What is your passion? MP: For me I have two really different aspects of my career that I am passion-ate about. Firstly, I am a family physi-cian and I connect with my patients. Secondly, I like to look at the larger pic-ture and ask: how can I take ideas from my practice and instead of helping two hundred people, help thousands?

TBB: Has there been a lot of support for your project? MP: EGADSS is supported by Vancou-ver Coastal Health through primary care transition funding. They have really helped build this project by being such a strong backer. Decision support is not easy, but it is important and they have taken a leap of faith here support-ing the start of this project. There has also been a lot of interest from the De-partment of Family Practice and from family doctors who would like to see a tool like this working in practice. I have had incredible support, personally, by several mentors in the Department and I would love to thank them, if I may, before we finish this interview. There are too many to name, but they know who they are: Thank you!

PAGE 9 THE BEAR BONES VOLUME 4 ISSUE 2

Dr. Morgan Price

Lead Faculty - Informatics, UBC

One of the Peter Grantham Award recipients, Dr. Aaron Childs of

Victoria

AC: In the continuing medical education rounds my presentation was on ‘Smoking Cessation and its Effectiveness in General Family Practice’ and I did a second one on Group B Strep Screening in Pregnancy and how effective my Family Practice Preceptor was doing in following the Guidelines for that. TBB: What were the outcomes? AC: The “Smoking Cessation...” presentation showed that family practitioners don't do enough in their offices targeting people who are smokers with prevention strategies. They don't persist enough in helping people to quit smoking. TBB: If they did, do your findings show that it works? AC: Yes, the rounds are given on effective strategies to help physicians help their patients to quite smoking and a lot of it is centred on scheduling regular follow-up supportive appointments using some of the newer pharmaceutical options available for people to quit smoking. It involves asking and encouraging people at every visit, not in a lecturing way but just in a simple acknowledgment, that “I as your doctor encourage you to stop smoking for your health”. Studies have shown the more that you do just those simple 1 min. to 15 sec statements, over time, can be more helpful than anything else that people do. TBB: What about nicotine patches? AC: Yes. Making sure that people have tried these things and telling them that they need to try them again. Just basically raising awareness. TBB: What if the doctor is smoking, then wouldn't it be difficult for them to give advice…. AC: There’s a fairly small percentage of

the medical community that actually smoke, at least in Victoria anyway. I don't think any of the residents smoke. I can think of only one or maybe two people in my medical class that smoked but not on a regular basis. It is not a big population of doctors that smoke, any more. TBB: What about drinking? You wouldn't have the same kind of thing for drinking? AC: My talk was specifically on smoking. There is a lot of research that shows that smoking has a detrimental effect in so many areas and is one of the biggest risk factors for the majority of the big health problems and drinking..., its less because people don't drink as much everyday as those who smoke. TBB: You are talking about cigarette smoking only? AC: Yes. TBB: And the other presentation? AC: It was on Group B Strep Screening in pregnancy. Part of the UBC research requirements for the residents is to do a clinical practice audit. Each resident does an audit of charts related to a specific problem to access how well the practice is following relevant practice guidelines. TBB: So you are checking on your preceptor? AC: You can look at it that way. Its done more as an educational learning exercise. I worked with my preceptor on an obstetrical problem and it turned out that we were doing quite well in that we were screening everybody appropriately and the right people were getting antibiotics. TBB: Anything else to add? AC: It was an honour to get this award. TBB: Congratulations!

PAGE 10 THE BEAR BONES VOLUME 4 ISSUE 2

TBB: How far are you in your medical education? AC: I am a First Year resident in Family Practice at the Victoria site as part of the UBC program. One year left to go and then I go out into Family Practice somewhere—place yet to be determined. TBB: How long have you been in school? AC: I did 4 years of undergraduate work at U of Waterloo and 4 years of Medicine at Queens U and then I subsequently arrived here in Victoria. TBB: What was this award about? AC: This award is part of the Peter Grantham awards which are given to residents in each site who have the most dynamic presentations or education sessions throughout the year and so I guess my site has chosen me as the person who has fulfilled that requirement. TBB: How many residents are there at the Victoria site? AC: 7 this year. Double to 14, next year TBB: What was your presentation on?

Interview with Award Winning Resident By Azmina Hasham

Is there a topic you would like to see in an upcoming issue of The Bear Bones? Or maybe there is a conference or grant competition you think your peers would be interested in. Let us know!

Dr. Stefan Grzybowski, Editor-in-Chief at 604-875-3281 or sgrzybowski@cw.bc.ca Azmina Hasham, Editor at 604-875-3658 or ahasham@cw.bc.ca ♦ Deadline for ideas for the spring issue is April 15, 2005 ♦

THE BEAR BONES PAGE 11 VOLUME 4 ISSUE 2

TBB: What compels you to do research? GO: I like to do research, because re-search pushes the forefront. When you’re with patients or when you are helping to set up a program, an enor-mous number of questions are gener-ated: “is this better than this?” or “how can I do this better?”. My research tends to be driven by questions that emerge from a clinical setting or from having to set up programs. TBB: What is the purpose of research? GO: Research is the foundation for improving the status quo in a thought-ful manner,.. TBB: What are the characteristics of a researcher? GO: An inquiring mind and passion. Passion is not something that can be taught, but once you find that passion you have to build on it, whether it be through mentorship, a structured pro-gram, or training. With research, you’re never funded adequately; you never have enough time so you have to love it enough to do it on top of every-thing else. TBB: What are your research interests? GO: I’m interested in the community and in marginalized populations. In addition, my research tends to be prag-matic. I started with HIV research be-cause where I started working in Ham-ilton, we had quite a large HIV prac-tice. I noticed that there was way more research done in HIV pertaining to men but not women, and so began researching HIV in women. Right now, I’m doing a study on the repro-ductive and contraceptive decisions of

HIV positive women. Since more and more women are living longer with HIV these issues of fertility and repro-duction become a much more real con-sideration. Then the other big area I’m interested in is general sexual health, STDs and cervical cancer screening which again that goes back to my work in Hamilton and continued with my work on the downtown eastside. TBB: What is your current research en-deavor? GO: It is a study on screening for cer-vical cancer using a test for the human papilloma virus. It is known that women won’t develop cervical cancer unless they have the human papilloma virus. Currently, we test for cervical cancer, using the Pap smear, and that is a relatively effective screening method as long as women get repeated Pap tests. However, 50% of women who develop cervical cancer have not been adequately screened, and my in-terest is on the 50% of women that de-velop cervical cancer who don’t get tested. There are a number of barriers as to why women don’t get tested for cervical cancer One of them is that there are some cultural concerns to having a pelvic exam We’re trying to look at different ways to test for it, and one of the different ways to test would be a self obtained sample for the hu-man papillomavirus. Our question is whether we can improve the rates of testing for cervical cancer in the cohort of women who normally don’t get Pap tests. TBB: What are your research goals? GO: My research goals are to continue to generate questions and studies that have relevance to the population and to its health. Likely it will continue in these areas as I am interested, I have developed an understanding of these issues, and I like them. TBB: What do you find most rewarding about your research? GO: Well, it’s nice to have your ques-tions answered. It’s nice to pose a question and eventually reach a con-clusion. For instance, this paper that is just getting published right now in the

Canadian Journal of Public Health. In Hamilton, we noted that our patients were not going for colposcopies. It was clear that our patients were not getting what they needed, and we wondered if there was a better of way of getting this service to them.. And so we set up a colposcopy program and we evalu-ated it and we showed that we are do-ing something better for them. And so I like posing these relevant questions and getting an answer and having an answer that you can apply. Then you can actually change something for the better. TBB: What do you see as your biggest success? GO: I would never define success by measures of my career. To me, success deals with the kind of person you are. To be a person with integrity, good humour, compassion – these are what it means to be successful; it has rela-tively nothing to do with my career. It has to do with how I raise my children, how I interact with family and friends. If I were to say my career was success-ful it would mean that I worked with colleagues in a manner that was re-spectful and had integrity and consid-erate of people and mindful our role in the public. What I’m most proud of in my career is that my work has rele-vance to the population. TBB: What advice do you have for people starting out -- for other researchers? GO: Find a mentor and hook up with that person. Recognize that research isn’t going to be done in two months, it takes years to decades. I would say find your passion. Think about your training and take some time to obtain the skills you need, whether that be in a formal or informal way. Talk, talk, talk to people, as many as you can, people who you think are good re-searchers. Meet with them and get ideas from them. All of us at the uni-versity expect to continuously talk and ask: “how do you ask that question?” or “What method would be best use for this research?” You need to start young and recognize that the role of faculty members is to be mentors so keep asking.

Dr. Gina Ogilvie

Assoc. Director, STD/AIDS Control

guided by our College’s principles for Family Medicine which commit us to: ■ respecting that the patient doctor

relationship and the needs of our patients are central to all we do;

■ building and maintaining our clinical skills, providing and coordinating a broad range of evidence-based health care for individuals and families throughout their lives;

■ being community-based physicians responding to patient and community needs through our offices, hospitals, nursing homes and other community settings;

■ being a resource to our practice and populations promoting health to prevent illness, providing and explaining health information, collaborating with and facilitating access to other care givers and advocating for patients throughout

the health care system.

Dr. Wedel added that he hoped that this declaration would be put up on doctors’ office walls. As well during the day there were 51 research presentations using a broad range of methods including qualitative (e.g. ‘Kwakwaka’wakw women’s experiences of leaving their community to give birth’), quantitative (e.g. ‘Is there gender bias in colorectal cancer screening’), systematic review (e.g. ‘Learning to dance with the devil: educating residents about the physician/pharmaceutical rep. interaction’), survey (e.g. ‘Family Practice residents in the face of communicable disease: how safe are we?’), descriptive study (e.g. ‘Little feet…..Big Feat! Having children during residency’), CME update (e.g. ’The new privacy legislation: how it will change your practice’), and case series report (e.g. ‘Family Practice applications of hyperbaric oxygen therapy’).

(Continued from page 1)

The budget is an important component of your grant application and it should reflect the actual costs of conducting research. Under-budgeting your project will not enhance the likelihood of receiving funding and the resulting lack of resources may cause difficulties in fulfilling your research goals. Budgets that are easy to read and well justified are appreciated by reviewers. Format Use a spreadsheet (i.e. Excel), as it will eliminate the need for manual calculations. Format the spreadsheet according to the requirements of the funding agency to which you are applying. If the funding agency uses a specific format (i.e. CIHR budget module), be sure your spreadsheet

lists the categories of expenses exactly as they appear in the funding agency’s template. Eligible expenses Examine the funding agency’s list of eligible expenses and include everything that you will need to successfully complete your project. Cost Estimates If funded, your project will take place many months from the date of your grant submission, so estimates for each line item should be based on future prices. Remember to include GST and/or PST in your estimates. Budget justification Provide a justification for each line item directly under the line item, unless otherwise stipulated by the funding agency’s guidelines.

Stipends for Research Trainees Include the funding agency’s maximum stipend allowable for graduate students and post-doctoral fellows. Include 22% benefits and a 5% annual salary increase for post-doctoral fellows. Salaries for Research Personnel Include the maximum salary allowable for each position, plus 22% benefits and a 5% annual salary increase. If you have any questions about budgeting or would like your budget reviewed prior to submission for funding, please feel free to contact:

The Research Office, Department of Family Practice, 604-875-3637 or research@familymed.ubc.ca

Budget Tips for Research Grants PAGE 12 THE BEAR BONES VOLUME 4 ISSUE 2

Contacts for help with your poster ► Research Office Department of Family Practice research@familymed.ubc.ca

► UBC Media Services Tel: 604.822.5769 Tips for PowerPoint posters: http://www.mediagroup.ubc.ca/powerpoint_tips.pdf Preparing posters FAQ: http://www.mediagroup.ubc.ca/faq.html Guidelines for posters: http://www.mediagroup.ubc.ca/powerpoint_guidelines.pdf

► St. Paul’s Media Centre Graphic Designer / Illustrator Providence Health Care Tel: 604.806.8312 Fax: 604.805.8474 eunderhill@providencehealth.bc.ca

Visit us online at www.familypractice.ubc.ca/b.html

POSTER TIPS