On October 15, the Kidney Function Clinic (KFC) located at St. Paul's Hospital reached a milestone with a visit from Mr. Len Cox, their 10, 000th patient. While everyone celebrated the occasion with cake and coffee, the Director of the clinic, Dr. Adeera Levin, spoke about the purpose and history of the clinic. Mr. Michael Marchbank, Chief Operating Officer of the Provincial Health Services Authority was in attendance.

The Kidney Function Clinic sees patients that are at different stages in the course of chronic kidney disease, but are not on dialysis. The Kidney Function Clinic offers education, counseling and clinical care to kidney disease patients, and is often the starting point for these patients into the health care system. Through their work, they aim to either delay the progression of kidney disease, or ensure wellness and preparation for dialysis or transplantation if delay or cessation of progression is not possible.

The Kidney Function Clinic at St. Paul's is the longest running clinic of its kind in Canada. The clinic started approximately 10 years ago as a research project that successfully showed that patients had better outcomes in a multidisciplinary setting. Subsequently, St. Paul's Hospital, and then the Ministry of Health, has funded the clinic care costs of patients prior to dialysis throughout BC as part of the budget for the Provincial Renal Agency. Congratulations to the Kidney Function Clinic for reaching this milestone, and their dedication to slowing the progression of kidney disease.

The Science Council of BC Awards were recently announced, and three Providence Health Care doctors have been acknowledged for their achievements in research. Drs. Michael O'Shaughnessy, Julio Montaner and Martin Schechter were awarded the Solutions Through Research award for their medical research which has led to increased knowledge and understanding of Human Immunodeficiency Virus (HIV). The award was presented on October 28th at the Fairmont Hotel Vancouver.

Dental hygiene is a serious problem among the elderly, and starting September 30th, Providence Health Care is now taking a giant step toward improving the dental health of our long term residents.

Along with the UBC faculty of Dentistry and the Vancouver Coastal Health Authority, the Centre for Aging and Health at Providence Health Care officially opened the first satellite clinics of the Geriatric Dentistry Program located at the Brock Farhni Pavillion and Youville Residence. The Program is needed because many private dental clinics are poorly equipped for the physical and cognitive limitations common among the frail elderly.

Made possible through generous funding from the St. Vincent's Hospital Foundation, the Geriatric Dental Program will bring preventative services and treatment to all of Providence's long-term care residents, either at the bedside, in UBC's Specialty Clinic or under general anesthetic at St. Vincent's Hospital. The program will also promote daily oral hygiene to residential staff, seniors and the community through education.

The first of its kind in Canada, the program will continue to grow, with more satellite clinics planned for Langara, Holy Family and Mount St. Joseph hospitals.

"Oral health treatment and preventative services are crucial to the quality of life of those in residential care," said Chris Wyatt, Program Leader for the Geriatric Dentistry Program. "The Geriatric Dental Program will benefit residents of Providence Health Care long-term care facilities and eventually, in the greater community."

In a recent study by the UBC Faculty of Dentistry, residents with access to an organized dental service had twice as many natural teeth, half as much tooth decay and fewer oral health problems such as gum disease.

New Cardiovascular Risk Reduction Clinic to open at St. Paul's Hospital

On September 26, 2002 - In recognition of the World Heart Federation's 3rd annual World Heart Day, Unilever Canada, the makers of Becel margarine, teamed up with St. Paul's Hospital to fight for the hearts of British Columbians.

With the assistance of British Columbians, a new Cardiovascular Risk Reduction Clinic is being established at St. Paul's Hospital, part of Providence Health Care, and is scheduled to open in the Spring of 2003. The new program will be the first clinic of its kind in British Columbia and its goal is to provide an individualized or tailored approach to lowering modifiable cardiac risk factors such as high cholesterol and smoking in order to prevent cardiovascular disease.

"The Cardiovascular Risk Reduction Clinic will be part of the hospital's Healthy Heart Program and expands upon the services provided in the Lipid Clinic and Cardiac Rehabilitation Clinic," says Sandra Barr, operations leader of St. Paul's Hospital's Heart Centre. "Treatments are based on the latest strategies backed by research and supported by a team of health-care professionals including physicians, dietitians, nurses and exercise specialists. The new clinic will be a provincial resource and will also be accessible to people living outside of the lower mainland. All British Columbians at risk of, or diagnosed with heart disease could potentially benefit from its services."

Cardiovascular disease is the leading cause of death in Canada. It is estimated that one in four Canadians has some form of heart disease or is at risk for stroke. In British Columbia last year, 6,887 people died from cardiovascular disease.

"We are pleased to support this prevention initiative as part of Unilever's support of World Heart Day activities," says Barbara Ledermann, registered dietitian and manager of the Becel Heart Health Information Bureau. "Making the important lifestyle and nutrition modifications to reduce cardiovascular risk can be challenging. It is important to have local support systems in place to encourage and help people make behaviour changes. This contribution demonstrates Becel's ongoing commitment to working with community groups and organizations to promote a heart healthy lifestyle."

For every container of Becel margarine sold in the province of British Columbia during October, 25 cents, up to a maximum for $50,000 will be donated to the establishment of the Cardiovascular Risk Reduction Clinic at St. Paul's Hospital.

World Heart Day, an annual event organized by the World Heart Federation, was established to increase awareness of the global impact of heart disease and stroke and to emphasize prevention that includes leading a healthy lifestyle. Sunday (September 29th) marked the Third Annual World Heart Day.

Providence Health Care is Canada's largest Catholic health care organization, with eight facilities in Vancouver including St. Paul's Hospital. The Heart Centre at St. Paul's Hospital is British Columbia's most comprehensive referral centre for patients with heart disease, a major teaching facility for cardiac professionals, and a leader in heart disease causes and treatments.

Sept. 24th the 200th transplant since the program began in 1988 was performed

St. Paul's surgeon Dr. Anson Cheung helped BC's heart transplant program celebrate two milestones on September 24 when he performed the province's first pediatric heart transplant-the 200th transplant since the program began in 1988.

The 11-hour transplant operation was performed at B.C.'s Children's Hospital by a surgical team led by Dr. Cheung, surgical director of heart transplantation at St. Paul's Hospital, and Dr. Suvro Sett, a cardiac surgeon at B.C.'s Children's Hospital.

Routinely, pediatric patients needing a heart transplant are sent to an out-of-province transplant centre specializing in pediatric heart transplants. In this case the patient, a five-year-old girl suffering from cardiomyopathy, was too unstable to be transferred.

"The transplant was a success in part because of the cooperation of the Heart Transplant Program at St. Paul's, BC.'s Children Hospital, and the BC Transplant Society," said Dr. Cheung. "This was a very unique situation, which thankfully had a positive outcome."

The first heart transplant in BC was completed at Vancouver General Hospital, in December 1988. The Heart Transplant Program moved to St. Paul's Hospital in 1996, so it could be a part of the newly formed Heart Centre.

On average, 15 people receive heart transplants each year in BC. To date, 13 heart transplants have been performed in 2002.

Providence Health Care and the St. Paul's Hospital Foundation were recognized recently with awards from the International Association of Business Communicators, BC Chapter (IABC/BC):

The Communications staff received awards in the Technical Writing category for a media release and backgrounder for a New England Journal of Medicine article on mitochondrial toxicity in HIV/AIDS patients, and in the Special Publications category "Don't Wait Major Time for Minor Emergencies."

Anne McLaughlin of the St. Paul's Hospital Foundation received an award in the Marketing category for the sinus surgery equipment campaign.

IABC is a worldwide, non-profit association providing 13,700 members in the communications industry with professional development, peer support and access to information banks and industry research.

IABC/BC's Blue Wave Awards is considered the premier awards program for BC's communications industry. Winning entries represent leading-edge communications efforts judged by industry peers in another province or state.

The awards were presented at a gala event June 6th at the Crowne Plaza Hotel Georgia.

Palliative care specialist Dr. David Kuhl's new book provides guidance and helpful strategies for people with terminal illness and their families.

Now an internationally renowned expert in his field, David helped to develop the Palliative Care Program at St. Paul's Hospital. His book - What Dying People Want: Practical Wisdom for the End of Life (Doubleday Canada) - is based on his research to seek better understanding of the psychological and spiritual pain of terminal illness. Funded by the Soros Foundation, the research involved extensive interviews with people who had terminal illnesses.

The book came about in part because so many of the patients interviewed during David's research study asked him to share their stories in a way that could help other patients and their families.

In the book, David addresses end-of-life realities - physical, psychological and spiritual - through his own experiences as a doctor and through the words and experiences of people who live with the knowledge that they are dying. What Dying People Want: Practical Wisdom for the End of Life is now available in bookstores. Published by Doubleday Canada in hardcover, it costs $34.95.

David will share his insight into What Dying People Want at speaking event sponsored by St. Paul's Hospital Foundation. It's set for 7 p.m., Tuesday, September 17 in the Pavilion Ballroom, Sheraton Wall Centre Hotel, 1088 Burrard Street, across from St. Paul's Hospital. Admission is free, but reservations are necessary. Call St. Paul's Hospital Foundation at 604-682-8206 or visit www.helpstpauls.com to book your seat.

Sandra Heath is the new Board Chair for Providence Health Care, replacing Janet Brown.

Sandra is a consultant specializing in training and human resources management with over 15 years in senior management positions in both the private and public sector. She was Director of Human Resources for the Vancouver office of Deloitte & Touche for six years, working with them through two significant mergers. Her work with Deloitte & Touche has taken her to the UK, Australia, New Zealand, across Canada and most recently to Russia delivering management and development programs.

Sandra holds memberships in the Human Resources Management Association, the Mediation Development Association of BC and Bard on the Beach Theatre Society.

Janet was Chair of the PHC Board since 2000. Prior to that she sat on the Joint Governance Board of PHC and the St. Paul's Hospital Board. Her extensive health care experience also includes service on the boards of the BC Health Association and the Council of University Teach Hospitals. She is currently Board Chair of the Catholic Health Association of Canada.

Michael Crean, Daniel Nocente and Sister Marilyn Kelly are also new to the PHC Board this year, replacing outgoing board members Bruce Jamieson, John Beckett and Sister Jean Gray.

This year's Providence Health Care Annual General Meeting was an opportunity to reflect on the events of the past year, celebrate partnerships and look ahead to future goals. The meeting was also a chance for Providence Health Care to publicly reaffirm their dedication to faith-based care.

Although the past year has been turbulent, Providence Health Care continues to build confidence in its work and future. The Providence Legacy Project, an eight-year plan that aims to consolidate patient services, renew our facilities and reform the delivery of health care, illustrates this. The project will position the organization for growth, improved care and working environments while reaffirming PHC's role as a leader in health care.

The past year has also seen strengthened relationships and newly fostered partnerships. PHC will strengthen its relationship with the Provincial Health Services Authority with future partnerships in programs like thoracic surgery, specialized diagnostics and tertiary mental health.

Reaffirming their commitment to the mission of healing, PHC Board of Directors and the Senior Leadership Team took part in a missioning ceremony during the AGM. Proclaiming their commitment, each member of the Board and Senior Leadership Team lit a candle as part of the ceremony conducted by Monsignor Rossi.

This year's AGM also saw the retirement of Board Chair Janet Brown and Board members Bruce Jamieson, John Beckett and Sister Jean Gray. Michael Crean, Daniel Nocentre and Sister Marilyn Kelly are new to the Board while Sandra Heath replaces Janet Brown as Chair.

For those with kidney failure on the North Shore, traveling to a dialysis unit has been an added stress. Until now. Providence Health Care and the Vancouver Renal Region officially opened the first community dialysis unit on the North Shore, June 20.

In the past, North Shore dialysis patients had to travel to St. Paul's Hospital, Vancouver Hospital or the Vancouver Community Dialysis Unit for their treatments, three-times-a-week. With a community dialysis unit closer to home, North Shore dialysis patients will experience reduced stresses associated with travel and maintain their personal lives with more ease.

"The biggest advantage is the convenience," says Bob Smith, who has been a dialysis patient for four years. Smith used to leave his home on the North Shore at 6:30 a.m. to beat the bridge traffic when he had to go to St. Paul's three-times-a-week. "Now the clinic is just four minutes away. I can walk there."

The additional resources associated with this new clinic, will improve the Vancouver Coastal Health Authority's ability to provide dialysis to both acute and chronic renal patients.

"This increase in capacity within the region will help alleviate pressures on existing dialysis units and provide improved patient access to services closer to their homes," says Lee Clarke, Director of the Renal Program for St. Paul's Hospital/Providence Health Care.

• Dialysis is a required procedure for patients with kidney failure. It is performed to replace the kidneys' failed function of filtering waste products and excess fluid from the blood.
• Dialysis is a temporary treatment for some, but for those whose loss of kidney function is permanent, dialysis is needed on a regular basis. The only other treatment for kidney failure is a kidney transplant.
• The unit will serve 24 patients using six dialysis chairs, with the possibility of serving 90 patients using 15 dialysis chairs in the future.
• Patients for this stand-alone dialysis unit have been selected based on their stability on dialysis and control of their underlying medical conditions. Individuals requiring more medical support will remain in the care of their home hospital.
• The North Shore Dialysis Unit opened its doors to patients May 12, 2002 and is located on #117-260 West Esplanade in North Vancouver.
• The dialysis unit was made possible with the support of the Ministry of Health, the Provincial Renal Agency and the Vancouver Coastal Health Authority.

Vancouver (April 23, 2002) — Providence Health Care, Canada's largest Catholic health care provider, today announced a major consolidation and redevelopment of its eight facilities that will renew the organization's ability to deliver patient care well into the new century.

Known as the Providence Legacy Project, the plan combines the consolidation of services now spread across aging facilities and multiple sites with strategic capital construction to significantly improve infrastructure, reshape and enhance services and improve cost effectiveness.

The Providence Legacy Project is the primary strategy Providence Health Care has presented to the provincial government to renew its care delivery. It was adjusted and modified to ensure it helped meet the three-year goal of a balanced budget by 2004/05. As a key partner in health care delivery, Providence Health Care has a responsibility to ensure its budget is balanced in this time frame.

"The Providence Legacy Project provides a blueprint for significant redesign of our organization. We believe this plan will be critical in renewing our organization's ability to deliver patient and resident care well into the future," said Carl Roy, Providence Health Care President and CEO. "We see this as the beginning of the renewal process for our organization and for health care throughout the province."

The Providence Legacy Project is an ambitious eight-year plan to leverage Providence Health Care's land and buildings in a way that will improve its capacity for patient and resident care. It will allow delivery of residential care in new ways that better suit the needs of older persons. It will enable an exciting synergy in research and academic areas through expansion. And it will allow consolidation of populations of patients and clients to provide better care in improved working environments.

The redevelopment also includes substantial public-private partnership opportunities, including badly needed infrastructure improvements. Funding for redevelopment will come from consolidation of Providence Health Care assets such as privately held land, private investment, new revenue generation and provincial government support.

"The Providence Legacy Project is critical to our three-year business plan, which has been approved by the Vancouver Coastal Health Authority and the Ministry of Health Services. We are confident that with additional tools from the Government of BC we will develop the public-private partnerships necessary to begin construction," said Roy.

• consolidate acute and rehabilitation services onto fewer sites;
• optimize clinical efficiencies and outcomes by creating a critical mass of similar work;
• reinforce our commitment to teaching and research by providing expanded research space and needed infrastructure improvements;
• improve physical working environments for our staff, physicians and volunteers;
• consolidate residential care onto fewer sites;
• leverage Providence land assets for strategic capital investment;
• maximize public-private partnership opportunities for facility renewal and redevelopment;
• ensure operational efficiencies and cost effectiveness while maximizing service levels and access to services;
• contribute to the province's successful realignment of health care services through voluntary consolidation;
• support strategic public reinvestment into innovative care models such as aging in place, independent living, assisted living, and specialized residential care services including complex care and chronic behaviour disorders; and
• be a useful template for BC's Health Authorities as they do their system redesign work.

"This is not just about buildings, this is about continuing the missions of our founding congregations, the five Orders of Sisters who for more than a century have tended to the health care needs of British Columbians," Roy said. "We want to ensure that the mission these remarkable women began will not only continue, but be strengthened. The Providence Legacy Project positions us for growth, for improved working environments, and for improving care for the many patients and residents we will serve in the years to come."

The Providence Legacy Project has received written approval and support from the Providence Health Care Society, the Providence Health Care Board of Directors and the Founding Congregations. A positive response was received from the City of Vancouver.

Providence Health Care was formed through the consolidation of three Catholic health care organizations in 1997. The organization is now owned and operated by the Providence Health Care Society. Care providers included in the group are Holy Family Hospital, St. Paul's Hospital, Mount Saint Joseph Hospital, St. Vincent's Hospitals (Heather, Langara, Brock Fahrni Pavilion and Arbutus) and Youville Residence.

Contact: Providence Health Care Communications Tel. 604-806-8022 Pgr. 604-667-4397 Providence Legacy Project Site Changes, Renewal and Redevelopment

St. Paul's Hospital (SPH)
St. Paul's Hospital's role is as Providence Health Care's academic acute care hospital serving an urban and provincial population. This role will be strengthen by consolidating all of St. Vincent's specialized surgical services (including related operating room, inpatient and ambulatory activity) and Holy Family Hospital's specialized rehabilitation services (including related inpatient and ambulatory activity).

• A new building on the corner of Thurlow and Comox streets would house the emergency department, now located in an old, seismically unsafe building. It would also be home to expanded mental health programs, ambulatory rehabilitation, clinical supports and parking.
• The Burrard Building, parts of which date to 1912, would be renovated and restored as one of the city's premier heritage structures. It would include commercial leased space, a Museum and Library, and a cafe and gift shop.
• A new tower (up to 350-400 feet) constructed on privately owned land on the northwest corner of Burrard and Davie streets would house consolidated health research facilities, enabling the relocation and expansion of existing research, ambulatory care and physician offices. Additional private partnership opportunities would include executive condominiums, retail and parking, and a private health fitness and recreation centre focused on prevention and integrated with Providence care systems.
• A new building, in the centre of the site following demolition, would house research space, retail space, parking, ambulatory, clinical support and physician offices, as well as a private 200-room accommodation facility, classroom learning labs and a licensed day care. This building would enable repatriation of all Providence off-site leased space and provide future flexibility and growth opportunities.

Mount Saint Joseph Hospital (MSJ)
Mount Saint Joseph Hospital is Providence's community acute care hospital. The Providence Legacy Project expands the hospital's role in providing care to elderly patients with complex physical and psychological needs. It supports MSJ's role in serving the acute and ambulatory care needs of a multicultural patient base and residents of Vancouver's east side. As well, it enables the full development of a 24-hour emergency department and strengthens MSJ's role in the provision of secondary surgery by consolidating all general surgery from St. Vincent's on this site. There would also be opportunities for expanded health discipline education to meet the teaching needs of UBC and other academic partners. The redevelopment plan includes:

• development (on separate land holdings) of a new building to house ambulatory care, retail opportunities and parking; and
• consolidation of current residential care off-site to realize MSJ's long term expanded acute role.

• consolidation of acute activity to the SPH site; and
• redevelopment of the SVH site for aging in place models, with independent living and assisted living environments.

• consolidation of redesigned rehabilitation services at SPH; and
• redevelopment of the site for aging in place models, with diverse housing and support options for seniors and other groups.

Residential Care
Providence's current configuration of residential care services includes a mixture of intermediate and extended care across seven sites — Youville Residence, St. Vincent's, Heather, Arbutus and Langara, Mount Saint Joseph, Holy Family and Brock Fahrni. Some of our residential care services are located in aging facilities that do not meet current standards of care.

• Providence-led redesign of our residential care services to enable opportunities for specialized services such as chronic behaviour disorder and complex care;
• public-private partnerships for facility redevelopment; and
• public and private reinvestment for aging in place models, including independent living and assisted living.

• continuation of Youville's multilevel care capacity, with the development l of complex care services (within the already approved development permit for 72 additional beds);
• continuation of Brock Fahrni's extended care capacity with an emphasis on serving war vets;
• maximum use of our best residential care facility, Langara;
• SVH site redevelopment to create aging in place models, including independent and assisted living for residents requiring the lowest degree of personal care;
• closure of residential care services at Arbutus, leaving the site available as Providence asset.

• A new building on the corner of Thurlow and Comox streets would house the emergency department, now located in an old, seismically unsafe building. It would also be home to expanded mental health programs, ambulatory rehabilitation, clinical supports and parking. Through a significant private initiative, the building would contain a community health fitness, recreation and education centre, focused on prevention and integrated with Providence care systems.
• A new building, housing research space, retail space, parking, ambulatory, clinical support and physician offices, as well as a private 200-room residential facility, classroom learning labs and a licensed day care. This building would enable repatriation of all Providence off-site leased space and provide future flexibility and growth opportunities.
• The Burrard Building, parts of which date to 1912, would be renovated and restored as one of the city's premier heritage structures. It would include retail and commercial leased space.
• A new tower (up to 350-400 feet) constructed on privately owned land on the northwest corner of Burrard and Davie streets would house consolidated health research facilities, enabling the relocation and expansion of existing research, ambulatory care and physician offices. Additional features would include executive condominiums, retail and parking.

• development (on separate land holdings) of a new building to house ambulatory care, retail opportunities and parking; and
• consolidation of current residential care off-site to realize MSJ's long term expanded acute role.

• consolidation of acute activity to the SPH site; and
• redevelopment of the SVH site for aging in place models, with independent living and assisted living environments.

• consolidation of redesigned rehabilitation services at SPH; and
• redevelopment of the site for aging in place models, with diverse housing and support options for seniors and other groups.

• Providence-led redesign of our residential care services to enable opportunities for specialized services such as chronic behaviour disorder and complex care;
• public-private partnerships for facility redevelopment; and
• public and private reinvestment for aging in place models, including independent living and assisted living.

• continuation of Youville's multilevel care capacity, with the development of aging in place models and specialized residential services (within the already approved development permit for 72 additional beds);
• continuation of Brock Fahrni's extended care capacity with an emphasis on serving war vets;
• maximum use of our best residential care facility, Langara;
• SVH site redevelopment to create aging in place models, including independent and assisted living for residents requiring the lowest degree of personal care;
• closure of residential care services at Arbutus, leaving the site available as Providence asset.

The concept of one-size-fits-all certainly doesn't apply when it comes to geriatric services. Many older seniors have a complex mix of physical, psychological and day-to-day living needs. Not surprisingly, finding the right service or range of services to meet these needs has often been a challenge for patients, families and care providers.

A team at Providence has tackled this challenge with a strategy to improve care for patients and provide a clear access point for physicians and other care providers in the community.

Providence provides a wide range of geriatric medicine, psychiatry and rehabilitation services through hospital beds, outpatient clinics, consultation services, day programs, home visits and residential care.

Because the eight facilities that form Providence Health Care only came together a few years ago, it's not surprising that until recently, geriatric care was handled differently by the numerous services across our hospitals. Admission criteria, protocols and data collection methods varied.

The planning team set in motion a range of activities to standardize care processes, to clarify the type and level of care provided by each service, and to develop one point of access for all patients. The long term goal is to ensure that patients, depending on their individual needs, can move easily between inpatient, outpatient and community services.

Great progress has been made and the work continues to ensure older adults have access to the best possible care that meets their complex needs.

A study by Dr. Stephan van Eeden and colleagues of the MacDonald Research Laboratories and iCAPTURE Centre at St. Paul's Hospital is the first to show a biological link between air pollution and increased risks of heart disease and stroke - a link previously suggested in numerous epidemiological studies.

In the study, air pollution is found to accelerate artherosclerosis - the cause of heart disease and stroke - by two times.

Like smoking, diabetes and high levels of blood cholesterol and blood pressure, fine particles found in pollution can lead to clogged arteries. But unlike smoking and other heart disease factors, there is little one can do about pollution.

"As everyone must breath, we are all exposed. You can't quit air pollution like you can smoking, and exercising outside may even make the problem worse," says van Eeden.

As we breathe, fine particles created by exhaust fumes and industry are inhaled into the lungs and specialized cells are alerted to remove the foreign matter. These cells then produce messengers (cytokines) that call other cells to help. This help message spills over into the blood vessels causing them to inadvertently illicit an immune response. The unnecessary response makes the blood vessels more permeable, allowing cholesterol and white blood cells to clog the vessel and increase the rate of artherosclerosis - the thickening and hardening of artery walls.

• This year air pollution will cause five to six thousand deaths in Canada, the majority of these heart and lung disease related, with those living in cities and industrial areas at most risk.
• Automobiles are the largest producer of particulate air pollutants but industries such as pulp mills can also contribute to this problem.
• Children and the elderly are most vulnerable. Children breathe faster and as a result their lungs are more exposed to pollution. This can aggravate asthma and cause lung infections. The elderly must battle pollution on top of other heart disease factors such as diabetes and high blood pressure.
• Van Eeden's study is published in this week's Journal of the American College of Cardiology.

Research by Dr. Julio Montaner of the BC Centre for Excellence in HIV/AIDS at St. Paul's Hospital has revealed the toxic side effects of commonly used HIV therapies and points to ways of mitigating these adverse reactions.

Writing in the New England Journal of Medicine, Montaner proposes that Anti-Retroviral Therapies (ART) can compromise the basic function of a cell's powerhouse - the mitochondria. When mitochondrial toxicity occurs as a side effect of ART, basic cell function is interrupted.

With mitochondrial toxicity occurs, patients can experience varying degrees of fatigue, shortness of breath on exertion, weight loss and a rapid heart beat. These side effects can become severe and life threatening.

In his paper, Dr. Montaner describes a new test that can measure actual mitochondrial levels in the blood. This is important since early results indicate that levels drop well before the toxicity becomes apparent and side effects develop. It is hoped that this test may allow caregivers to predict the development of mitochondrial toxicity and eventually adjust or optimize ART before side effects even develop.

"Modern anti-retroviral therapy is highly effective, and has transformed HIV/AIDS into a long term, manageable condition. The challenge remains to keep ahead of emerging toxicities. Ultimately we hope that this test will allow us to continue to maximize the impact of currently available therapies," said Dr. Montaner.

• Dr. Montaner's paper was published in the March 11 edition of the New England Journal of Medicine (NEJM).
• Dr. Montaner's team at St. Paul's Hospital is currently evaluating the value of this test in several clinical research protocols.
• An important power supply for the body, mitochondria thrive on turning cellular waste into energy for the body.
• In normal cellular activity, the mitochondria operates as part of a finely tuned symbiotic relationship, converting glucose into energy and breaking down cell waste such as lactic and pyruvic acids in the process. This process can be compromised by HIV medication and patients can suffer serious side effects.
• Many aspects of anti-retroviral therapy were pioneered at Providence Health Care including the refinement of highly effective multi-drug cocktails used to dramatically reduce the death rate from HIV/AIDS.

Dr. Julio Montaner has won a $1 million grant for his breakthroughs in HIV/AIDS treatment and research. Montaner is Director, Clinical Activities for the BC Centre for Excellence in HIV/AIDS, located at St. Paul's Hospital.

The Boehringer Ingelheim Distinguished Researcher Award is one of the largest single awards of its kind, and comes from Boehringer Ingelheim, a global leader in virology research.

Dr. Montaner, who is also a founding co-director of the Canadian HIV Trials Network and a Professor of Medicine at the University of British Columbia, will use the $1 million to endow a professorship in health outcomes research in HIV/AIDS in cooperation with UBC.

• A pioneer of the multiple drug "cocktail," Dr. Montaner's team is the only one in Canada to practice Therapeutic Drug Monitoring (TDM). TDM seeks to understand why certain medications succeed at treatment and some do not.
• With colleagues at UBC, Dr. Montaner's work in salvage therapy has been able to successfully treat 75 per cent of patients who would have otherwise been deemed untreatable by standard guidelines.
• Dr. Montaner's research is now focused on simplifying antiretroviral therapy and the management of multiple drug resistant HIV. He has also initiated a new effort to characterize the long-term safety of antiretroviral therapies.
• Due in large part to treatment methods developed and advanced by Dr. Montaner and his team, HIV is now considered a chronic disease and not the death sentence it was just 10 years ago.

Family violence is recognized by health care professionals as a major public health concern. For many people who are abused and isolated, emergency rooms are the first point of contact where they feel safe to disclose the abuse. With this in mind a Domestic Violence Intervention Program is in place at St. Paul's and Mount Saint Joseph's hospitals. Vancouver Hospital is also a site for the program.

The Domestic Violence Intervention Program, which involves the work of nurses, physicians, social workers and health care students, attempts to break the cycle of abuse starting at the moment the victim enters the Emergency room. The program screens all Emergency room patients and provides supportive counselling, documentation and referral information to patients who have disclosed domestic violence.

Domestic violence resource cards listing names and numbers of crisis lines, transition houses and other resources for abused persons and abusers are available at admitting and in washrooms. As part of the program, initiatives as simple as placing a Domestic Violence Resource card into the shoe of a victim has been effective at supporting victims and letting them know that help is available. Even just asking patients whether or not they are victims of domestic violence has gone a long way to creating survivors.

In the past ER staff felt unsure of the best way to approach potential domestic violence victims and were concerned patients may be offended when approached. Staff were also concerned about time constraints and the magnitude of the problem.

Realizing these issues, seven St. Paul's Hospital Emergency nurses, Lisa Moralejo, Tom Sinclair, Kathy Kennedy, Joanna Caunter, Harry Turner, Elisa Marocchi, Heather Clark, and former Nurse Educator, Jude Poirier, volunteered their time to create a video that documented their participation in the Domestic Violence Screening Program. The video addresses the concerns of ER staff in undertaking the program and share's the personal stories, difficulties, and triumphs these seven nurses experienced while making the program a part of their professional practice.

The video has been extremely effective at helping ER staff with their uneasiness and has become an essential educational tool for many nurses, medical students, and other health care workers outside of the program.

Nurses, physicians, social workers, students and survivors have commended these nurses for their initiative and success in raising awareness of the program and its benefits. The video also received an incredible response at the "Nursing Network on Violence Against Women International" conference in Madison, Wisconsin.

For more information on Domestic Violence check out the Ministry of Health Womens Equity web site at www.gov.bc.ca/weq/

Volunteers are needed for a study that looks at the use of light therapy instead of antidepressant medication to treat postpartum depression - an illness that affects approximately 10 - 20 per cent of women the first six months after childbirth.

The study, which began in 2000, is the first to examine light therapy as a treatment for postpartum depression.

"This is the first study of its kind, anywhere in the world," said Dr. Maria Corral of the Reproductive Mental Health Program at St. Paul's and BC Women's hospitals. Dr. Corral is conducting the study with Dr. Sheila Patton of the same program.

"Light therapy has successfully treated premenstrual syndrome and it is effective with seasonal and non-seasonal depression. We thought it could potentially be a useful choice for women suffering from postpartum depression," said Dr. Corral.

Antidepressants can also be an effective treatment for postpartum depression, but many mothers who are breastfeeding are concerned about possible adverse effects of these medications on the developing child. As a result, "some woman may be reluctant to seek help for their illness," said Dr. Corral.

Untreated, postpartum depression may contribute to family/marital breakdown, self-harm, suicide and/or infanticide, and the development of a chronic and persistent mood disorder. It can also have harmful effects on the child's cognitive, emotional, and social development and on the maternal-infant bond. Light therapy provides a potentially safe, alternative treatment for postpartum depression.

For this study, patients sit as close as comfortably possible to a light therapy box daily for six weeks. Patients must sit in front of the light therapy box 30 minutes at a time. The patient can read, write, or eat while sitting under the light, but is not to stare directly into it. The patients undergo the light therapy at home.

The light box contains cool white fluorescent bulbs, similar to those found in an office or home, and emits minimal ultraviolet (UV) light. However, the small amount of UV light emitted is absorbed by filters in the box so that patients are not exposed to harmful rays. A light therapy box will be lent to participants during the course of the postpartum study.

Women who have given birth to a child in the last six months, are depressed and don't want to take medication, are eligible for the study. Interested participants can contact Xanthoula Kostaras, Research Assistant, at 604-682-2344 local 62256, for more information.

Through a proclamation initiated by the Eating Disorder Resource Centre of BC (EDRCBC), Mayor Philip Owen and the Provincial Government have declared February 3 - 9 "National Eating Disorder Awareness Week" for the City of Vancouver and the Province of British Columbia.

The theme of Eating Disorder Awareness Week is "What does your body mean to you? Mind, Body, Spirit!"

The EDRCBC is located in St. Paul's Hospital, and Providence Health Care is also home to the adult eating disorder program for BC.

As part of Eating Disorder Awareness Week, the EDRCBC is challenging the media to raise awareness of disordered eating through editorials, talk shows, and stories about unrealistic body image and fat phobia.

The EDRCBC is also sponsoring a series of events at the Children's Library, YMCA, YWCA, SFU Harbour Campus and the Roundhouse. Topics of discussion will include: substance abuse and disordered eating, exercise and eating disorders, panel of survivors and those who love them, fat phobia and obesity and what parents can do to help their children.

To receive a copy of the proclamation, information on these events, or help locating resources on eating disorders, call the EDRCBC at 604-806-9000, toll free in BC at 1-800-665-1822, or at www.disorderedeating.ca.