This month, I attended the Surgery and Diagnostic Imaging Advisory Council Meeting for the Access to Care Program which is part of Cancer Care Ontario.  At the meeting, we heard an important presentation by representatives of the Ministry of Health and Long-Term Care (MOHLTC) regarding Health System Funding Reform for the province of Ontario.  In fact, we were fortunate to hear an earlier presentation of this material at our Strategic Planning Retreat in January from Assistant Deputy Minister, the Honourable Saad Rafi.  In essence, the new plan is taking us from a provider-centred funding model to a patient-centred funding model, where funding will be based on the services provided.  The reason health care reform is required at this time is self-evident:  Health care consumes 42 cents of every dollar spent on provincial programs;   a system is required that improves quality for patients as it delivers increased value for taxpayers; and care providers should be rewarded for ensuring better patient outcomes.  Interestingly, Ontario is one of the last jurisdictions to move down this particular pathway of reform.  Traditionally, Ontario hospitals have been funded on a global basis.  As we heard from Mr. Rafi, this will be changing towards a model that focuses on patients.  According to the MOHLTC, patient focused funding is evidence-based, targeted and transparent, supports quality improvement, and encourages health service providers to become more efficient through clinical best practice and specialization.  The MOHLTC plans to phase-in its model of patient focused funding over 3 years.  Funding will be based on a  Health Based Allocation Model (HBAM) and Quality-Based Procedures (QBPs).  HBAM and QBPs will comprise 70% of total funding, with global budget funding occupying the other 30%.  For us as surgeons, it is important to know that in Year 1, proposed QBPs  include unilateral hip and knee replacements.  Given the success with the provincial programs to reduce wait times for cataract surgery, hip and knee replacements, and chronic kidney disease, future funding in this system will be redirected towards other priority areas.  An evidence-based framework will be used for selecting QBPs in the future.  There is no question that we can expect some redistribution of funding across hospitals and from the acute care setting to the community setting.  The MOHLTC has stated it will provide smooth transitioning of funding to minimize the impacts of any swings in funding over the next 3 years.  We are indeed fortunate that, as part of our Strategic Plan, we have made Quality/Best Practices one of our new strategic goals in the Department of Surgery.  For this, I should like to thank Robin McLeod once again for her leadership with the Best Practices in General Surgery (BPiGS) initiative which has gained substantial momentum, and is the template we will use with all Divisions to determine what are our best practices for all surgical procedures where these can be measured.  In the end, I strongly believe we can assist the MOHLTC in laying the groundwork for delivering the highest quality care for Ontarians undergoing surgery.

James T. Rutka, MD, PhD, FRCSC 
RS McLaughlin Chair 


John Palmer Lecture (University Rounds)
April 13, 2012, 7:30 a.m. – 8:30 a.m.
Hollywood Theatre, 1st Floor, Elm Street Wing,
The Hospital for Sick Children
Michael Choti, MD
The Jacob C. Handelsman Professor of Surgery, and Chief of the Handelsman Division of Surgical Oncology
Department of Surgery, Johns Hopkins

"Image-Guided Liver Surgery: Current Status and Future Directions" 

Trauma Association of Canada Annual Scientific Meeting
Dates: April 12 - 13, 2012
Location: The Hilton Toronto
Registration Information:

Gallie Day 2012
The Scientific Proceedings of Gallie Daywill be held on Friday May 4, 2012 at the MaRS Complex Auditorium.  Gallie Day Dinner and Awards Ceremony will take place at the Royal York Fairmont Hotel.  Please mark your calendars now.


The Harland Smith Lecture (University Rounds) was held on Thursday, March 29th, 2012 at UHN, Toronto Western Hospital.  Dr. Daniel Riew, Chief, Cervical Spine Surgery, Washington University, St. Louis spoke on Anatomical Considerations in Cervical Spine Surgery”.  

On the Nature of Stroke Prevention
This month, a research study from Michael Tymianski’s laboratory was published in Nature.   Michael is Professor of Neurosurgery at the University of Toronto, and Senior Scientist in the Toronto Western Hospital Research Institute.  Stroke is a leading cause of death and disability.  To identify a strategy for improving stroke therapy, where previously so many trials and agents have failed, Michael and his co-authors used an inhibitor to postsynaptic density protein (PSD)-95, an inhibitor that Michael had previously demonstrated to be effective in the prevention and minimalization of brain injury after stroke, to show that this inhibitor could be effective in the brains of non-human primates (2).  Cerebral infarct volumes were reduced after inhibitor therapy  as measured by magnetic resonance imaging (MRI), histology, and behavioural and neurological examinations.  Their research findings are exciting and timely, as they suggest that neuroprotection using PSD-95 inhibitors in humans should also be possible to improve stroke outcome in patients.  The first author on Michael’s publication is DJ Cook, a neurosurgery resident enrolled in the Surgeon Scientist Program (SSP) in the Department of Surgery at the University of Toronto. Congratulations to Michael on this high impact publication!

In Memorium - Tait McPhedran
Dr. Tait McPhedran passed away In Calgary, AB on March 13, 2012 in his 88th year.  Dr. McPhedran held a faculty appointment in General Surgery, Toronto General Hospital, Department of Surgery, University of Toronto from 1957 to 1969.  He then went to the new University of Calgary Medical School and was appointed Professor and Head of the Department of Surgery and Chief of Surgery at Foothills Hospital until his retirement in 1991.
The Ajmera Family Chair in Urologic Oncology
Dr. Robert Nam has been appointed to the Ajmera Family Chair in Urologic Oncology for a term of 5 years effective April 1, 2012.  He is Head, Genitourinary Cancer Care and Active Staff Physician; Associate Scientist

at Sunnybrook Health Sciences Centre. 
The primary vision of the Ajmera Family Chair in Urologic Oncology is to pursue and achieve clinical and research excellence in the field of prostate cancer. 
Appointment of Chair, Department of Medical Imaging
Professor Alan Moody has been appointed as Chair of the Department of Medical Imaging in the Faculty of Medicine, University of Toronto.  Dr. Moody is Radiologist in Chief at Sunnybrook Health Sciences Centre and an associate scientist within the Imaging Research Discipline of the Sunnybrook Research Institute as part of the Schulich Heart Research Program.
Surgical Robot Used to Treat Lung Cancer for First Time in Canada at Toronto General Hospital
For the first time in Canada, surgeons at Toronto General Hospital (Kazuhiro Yasufuku; Tom Waddell) have used a robotic surgical system to treat early-stage lung cancer by removing the cancer, along with the lobe of the lung.  The surgery was done in October and the patient remains cancer-free.  This less invasive procedure leads to a reduction in pain, and an earlier discharge from hospital.
Appointments to the Institute of Medical Science Graduate Studies
Dr. Gelareh Zadeh(Neurosurgery) has been appointed as an Associate Member.
Dr. Mark Cattral (General Surgery)has been reappointed as a Member.
Dr. Neil Fleshner (Urology)has been reappointed as a Member.
Dr. Gelareh Zadeh (Neurosurgery)has been appointed as full time faculty at STTARR (Spatio-Temporal Targeting and Amplification of Radiation Response).
Shafie S. Fazel Outstanding Resident Surgeon and Investigator Award in memory of Dr. Shafie S. Fazel, an outstanding resident within the Division of Cardiac Surgery, University of Toronto.  The award will be presented annually to a senior resident in his or her last year of training within the Department of Surgery, University of Toronto, who has demonstrated outstanding accomplishments during their residency both as a surgeon and as an investigator.   Each division within the Department of Surgery will be asked to submit the name of one potential candidate. Nominations must be accompanied by a letter of support from the division’s Program Director, outlining how the nominee meets the criteria. The deadline for submission of nominations is March 31, 2012. The award will consist of a monetary prize in the amount of $1000.00, along with a plaque bearing the name of Dr. Shafie S. Fazel. 
Slo-pitch Tournament 
The Department of Surgery will be hosting a slo-pitch tournament in the spring of 2012.  If you would be interested in signing up for this event, please let Stephanie know at s.neilson@utoronto.caor 416-946-4003. 
The following Continuing Appointment Reviews (CARs) took place this month under the leadership of Ori Rotstein, Associate Chair, Department of Surgery:

Ralph George
Ralph is an Associate Professor of General Surgery, and head of the CIBC Breast Centre at St Michael's Hospital.  He graduated from medical school at Queen's University, and did fellowship training at Roswell Park Cancer Institute in Buffalo, New York. Ralph has held previous faculty appointments at Memorial University in St Johns Newfoundland, and Queen's University in Kingston.  An outstanding teacher, Ralph has won numerous teaching awards throughout his career.  He is Chair of the Specialty Committee of the Royal College of Physicians and Surgeons in General Surgery, and President Elect of the Canadian Association of General Surgeons.

Kazuhiro Yasufuku
Kazuhiro received his MD and his PhD from Chiba University in Japan.  He did fellowship training in the lung transplantation program in Toronto, before being recruited as an Assistant Professor in Thoracic Surgery in 2008.  Currently, he is the Director of the Interventional Thoracic Surgery Program at UHN.  He is a member of numerous professional organizations.  Kazuhiro has received several grants for his research work over the years, and has published over 90 peer reviewed articles.  One of his main areas of expertise is in the use of endobronchial ultrasound to diagnose and stage lung cancers in patients.  His work on the use of robotics in thoracic surgery was cited recently in the Toronto Star and Globe and mail.

Pioneer in Medicine Award - Society of Brain Mapping and Therapeutics
Dr. Andres Lozano (Neurosurgery, Dept. of Surgery, Toronto Western Research Institute) has been selected as a recipient of the prestigious Pioneer in Medicine Award from the Society of Brain Mapping and Therapeutics (SBMT), to be presented as part of their 9th Annual World Congress in Toronto in June 2012. This award is presented to individuals who have significantly contributed to scientific advancements in the fields of medicine and image guided therapy through a multi-disciplinary approach. Dr. Lozano is noted as one of the foremost authorities in the field of Deep Brain Stimulation (DBS), and is being recognized for breaking new ground in the treatment of depression, obesity and Alzheimer's disease using DBS.
Dr. Peter Ferguson (Orthopaedics) is one of two recipients selected for a 2012 Award for Excellence in Postgraduate Medical Education in the category of Development and Innovation.
Dr. Robert Mustard (General Surgery) is one of two recipients selected for a 2012 Awards for Excellence in Postgraduate Medical Education in the category of Teaching Performance, Mentorship and Advocacy. 

Dr. Gelareh Zadeh (Neurosurgery) is the recipient of the 2012 Lois H. Ross Resident Advocate award from PAIRO.

Dr. Paul Greig (General Surgery) received the Distinguished Service Award from the American Hepato-Pancreato-Biliary Association (AHPBA).

Drs. Frederick Brenneman and Sandro Rizoli had both of their proposals to the AFP Innovation Fund awarded. 
Dr. Frederick Brenneman  (General Surgery) Abdominal Wall Reconstruction for Complex Ventral Hernias Using a New Porcine Biologic Tissue Matrix
Dr. Sandro Rizoli (General Surgery) Implementation of a Remote Thromboelastometry-guided Transfusion Algorithm to Improve Transfusion Decision in Trauma

Atesok K, Matsumoto T, Karlsson J, Asahara T, Atala A, Doral MN, Verdonk R, Li R, Schemitsch E.  An emerging cell-based strategy in orthopaedics: endothelial progenitor cells.  Knee Surgery, Sports Traumatology, Arthroscopy. E-published March 9, 2012.

Bezuhly M, Fischbach S, Klaiman P, Fisher DM.  Impact of 22q Deletion Syndrome on Speech Outcomes following Primary Surgery for Submucous Cleft Palate.  Plastic and Reconstructive Surgery, 129(3):502e-510e, 2012.

Bezuhly M, Fisher DM.  Single-stage repair of asymmetrical bilateral cleft lip with contralateral lesser form defects.  Plastic and Reconstructive Surgery, 129(3):751-757, 2012.

Bhindi B, Trottier G, Elharram M, Fernandes KA, Lockwood G, Toi A, Hersey KM, Finelli A, Evans A, van der Kwast TH, Fleshner NE.  Measurement of peri-prostatic fat thickness using transrectal ultrasonography (TRUS): a new risk factor for prostate cancer.  British Journal of Urology International. E-published February 28, 2012.

Chin JW, Teague L, McLaren AM, Mahoney JL.  Non traumatic lower extremity amputations in younger patients: an 11-year retrospective study.  International  Wound Journal.  E-published February 13, 2012.

Cook DJ, Teves L, Tymianski M.  Treatment of stroke with a PSD-95 inhibitor in the gyrencephalic primate brain.  Nature 483:213-217, 2012.

Cook DJ, Tymianski M.  Nonhuman primate models of stroke for translational neuroprotection research.Neurotherapeutics, March 22, 2012. [Epub ahead of print]

Coroneos CJ, O'Sullivan B, Ferguson PC, Chung PW, Anastakis DJ.  Radiation Therapy for Infiltrative Giant Cell Tumor of the Tendon Sheath.  Journal of Hand Surgery American. E-published March 1, 2012. 

Cruz JP, Chow M, O'Kelly C, Marotta B, Spears J, Montanera W, Fiorella D, Marotta T.  Delayed Ipsilateral Parenchymal Hemorrhage Following Flow Diversion for the Treatment of Anterior Circulation Aneurysms.  American Journal of Neuroradiology.  Epublished March 8, 2012.

David TE.  Aortic valve repair for active infective endocarditis.  European Journal of Cardio-thoracic Surgery.  E-published February 15, 2012.

David TE.  Remodelling of the sinotubular junction to correct aortic insufficiency.  European Journal of Cardio-thoracic Surgery.  E-published March 4, 2012.

Diaz RJ, Golbourn B, Shekarforoush M, Smith CA, Rutka JT.  Aurora Kinase B/C inhibition impairs malignant glioma growth in vivo.  Journal of Neuro-oncology.  E-published March 1, 2012.

Domes T, Lo KC, Grober ED, Mullen JB, Mazzulli T, Jarvi K.  The incidence and effect of bacteriospermia and elevated seminal leukocytes on semen parameters.  Fertility and Sterility.  E-published February 16, 2012.

Fehlings MG, Vaccaro A, Wilson JR, Singh A, Cadotte D, Harrop JS, Aarabi B, Shaffrey C, Dvorak M, Fisher C, Arnold P, Massicotte EM, Lewis S, Rampersaud R: Early versus delayed compression for traumatic cervical spinal cord injury: Results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS).  PLoS ONE. 2012;7(2):e32037.

Gani J, Perlis N, Radomski SB.  Urologic medications and ophthalmologic side effects: a review.    Canadian Urological Association Journal.  6(1):53-8, 2012.

Haykal S, Soleas JP, Salna M, Hofer S, Waddell TK.  Evaluation of the Structural Integrity and Extracellular Matrix Components of Tracheal Allografts following Cyclical Decellularization Techniques: Comparison of Three Protocols.  Tissue Engineering Part C Methods. E-published February 14, 2012.

Hodaie M, Chen DQ, Quan J, Laperriere N.  Tractography delineates microstructural changes in the trigeminal nerve after focal radiosurgery for trigeminal neuralgia.  PLoS One. 7(3):e32745. Epublished March 6, 2012.

Ingraham AM, Haas B, Cohen ME, Ko CY, Nathens AB.  Comparison of Hospital Performance in Trauma vs Emergency and Elective General Surgery: Implications for Acute Care Surgery Quality Improvement.  Archives of Surgery.  E-published March 19, 2012. 

Karkouti K, Wijeysundera DN, Yau TM, McCluskey SA, Chan CT, Wong PY, Crowther MA, Hozhabri S, Beattie WS.  Advance Targeted Transfusion in Anemic Cardiac Surgical Patients for Kidney Protection: An Unblinded Randomized Pilot Clinical Trial. Anesthesiology, 116(3):613-621, 2012.

Knowles R, Veldtman G, Hickey EJ, Bradley T, Gengsakul A, Webb GD, Williams WG, McCrindle BW.  Functional Health Status of Adults With Tetralogy of Fallot: Matched Comparison With Healthy Siblings.  Annals of Thoracic Surgery.  E-published March 17, 2012.

Kuzyk PR, Shah S, Zdero R, Olsen M, Waddell JP, Schemitsch EH.  A biomechanical comparison of static versus dynamic lag screw modes for cephalomedullary nails used to fix unstable peritrochanteric fractures.  Journal of Trauma and Acute Care Surgery. 72(2):E65-70, 2012.

La Scala GC, Oʼdonovan DA, Yeung I, Leong I, Mendes M, Rogers M, Neligan PC, Pang CY, Forrest CR.  Local Hemodynamic Effects of Radiation on the Rabbit Orbitozygomatic Complex with and without Cytoprotection.  Plastic and Reconstructive Surgery,129(3):599-608, 2012.

Lee JY, Mucksavage P, Kerbl DC, Huynh VB, Etafy M, McDougall EM.  Validation study of a virtual reality robotic simulator--role as an assessment tool?  Journal of Urology, 187(3):998-1002, 2012.

Li SH, Sun Z, Guo L, Han M, Wood MF, Ghosh N, Alex Vitkin I, Weisel RD, Li RK.  Elastin overexpression by cell-based gene therapy preserves matrix and prevents cardiac dilation.  Journal of Cellular and Molecular Medicine.  E-published March 21, 2012.

Lozano AM, Giacobbe P, Hamani C, Rizvi S, Kennedy S, Kolivakis TT, Debonnel G, Sadikot A, Lam RW, Howard A, Ilcewicz M, Honey CR, Mayberg HS.  A multicenter pilot study of subcallosal cingulate area deep brain stimulation for treatment resistant depression.  Journal of Neurosurgery, 116(2):315-22, 2012.

Macdonald RL.  Editorial: Mirror aneurysms.  Journal of Neurosurgery.  Epublished March 9, 2012.

Margel D, Yap SA, Lawrentschuk N, Klotz L, Haider M, Hersey K, Finelli A, Zlotta A, Trachtenberg J, Fleshner N.  Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study.  Journal of Urology. 187(4):1247-1252, 2012.

Margel D, Bostrom P, Baniel J, Yossepowitch O, Zlotta A, Fleshner N.  External validation of a biomarker based pre-cystectomy algorithm to predict nonorgan confined urothelial cancers.  Journal of Urology. 2012 187(3):840-844, 2012.

Pirouzmand F.  Epidemiological Trends of Traumatic Optic Nerve Injuries in the Largest Canadian Adult Trauma Center.  Journal of Craniofacial Surgery.  E-published  March 15, 2012.

Salle JL, Lorenzo AJ, Jesus LE, Leslie B, AlSaid A, Macedo FN, Jayanthi VR, de Castro R.  Surgical treatment of high urogenital sinuses using the anterior sagittal transrectal approach: a useful strategy to optimize exposure and outcomes.  Journal of Urology, 187(3):1024-1031, 2012.

Shahrokhi S, Jindal K, Jeschke MG. Three components of education in burn care: Surgical education, inter-professional education, and mentorship.  Burns. E-published February 21, 2012.

Somogyi RB, Ahmad J, Shih JG, Lista F.  Venous thromboembolism in abdominoplasty: a comprehensive approach to lower procedural risk.  Aesthetic Surgery Journal, 32(3):322-329, 2012.

Standish BA, Spears J, Marotta TR, Montanera W, Yang VX.  Vascular Wall Imaging of Vulnerable Atherosclerotic Carotid Plaques: Current State of the Art and Potential Future of Endovascular Optical Coherence Tomography.  American Journal of Neuroradiology.  E-published March 8, 2012.

Van Poppel H, Klotz L.  Gonadotropin-releasing hormone: An update review of the antagonists versus agonists.  International Journal of Urology. E-published March 14, 2012.

Wang RY, Li R, Zdero R, Bell D, Blankstein M, Schemitsch EH.  The Physiologic and Pathologic Effects of the Reamer Irrigator Aspirator on Fat Embolism Outcome: An Animal Study.  Journal of Orthopaedic Trauma.  E-published February 25, 2012.

Welk BK, Herschorn S.  The autologous fascia pubovaginal sling for complicated female stress incontinence.Canadian Urological Association Journal. 6(1):36-40, 2012.

Wilson JR, Fehlings MG.  Management strategies to optimize clinical outcomes after acute traumatic spinal cord injury: integration of medical and surgical approaches.  Journal of Neurosurgical Sciences. 56(1)1-11, 2012.

Yanagawa B, Lovren F, Pan Y, Garg V, Quan A, Tang G, Singh KK, Shukla PC, Kalra NP, Peterson MD, Verma S.  miRNA-141 is a novel regulator of BMP-2-mediated calcification in aortic stenosis.  Journal of Thoracic Cardiovascular Surgery.  E-published February 13, 2012.

Zhang ZJ, Koifman J, Shin DS, Ye H, Florez CM, Zhang L, Valiante TA, Carlen PL.  Transition to Seizure: Ictal Discharge Is Preceded by Exhausted Presynaptic GABA Release in the Hippocampal CA3 Region.  Journal of Neuroscience. 15;32(7):2499-512, 2012.
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