Creating the Health Care Team of the Future: The Toronto Model for Interprofessional Education and Practice

[Excerpt] In 2000, the Institute of Medicine\u27s landmark report To Err Is Human launched the contemporary patient safety movement with its clarion call to the health care systems all over the globe to act to prevent the errors that kill over 100,000 patients a year and harm many thousands more in the United States alone. Ten years later, in 2010, the World Health Organization\u27s (WHO) Framework for Action on Interprofessional Education and Collaborative Practice was released, as was the Lancet Commission report Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. In fact, over the past decade or more, studies have documented that, far from improving, in countries such as the United States and Canada, there has been little progress in preventing patient deaths and harm. Original calculations such as those done by the Institute of Medicine in 2000 are now considered to have been dramatic underestimations of the harm done to patients in health care institutions around the world. Although the complexity of today\u27s high-tech health care systems is often used as a rationalization for the maintenance of the status quo, all these groundbreaking reports argue that team-based, or interprofessional, care is a key strategy to move our current underperforming health care systems toward a more safe, efficient, integrated, and cost-effective model. Contemporary health care institutions do indeed have a bewildering number of players. Despite this, the responsibility for ensuring that patients receive the right care at the right time from the right providers relies on a few basic principles: Practitioners need to understand they are part of a diverse team. Practitioners must communicate effectively with the patient and family, as well as with other members of their team. Practitioners need to know what other team members do to limit duplication and prevent gaps in care. Practitioners need to know how to work together to optimize care so that the patient journey from inpatient care to home care, or from primary care to the specialist clinic is experienced as seamless. Since 2000, the eleven health professional programs at the University of Toronto and the forty-nine teaching hospitals associated with them have developed an Interprofessional Education and Care (IPE/C) program that begins in the first year of a health professional student\u27s entry into his or her program, continues through various educational activities throughout their studies, and straddles the education/practice divide. Over the past decade, the university and teaching hospital partners have been engaged in the co-development and support of the IPE curriculum for learners. They are also investing in the development of faculty and the ongoing training of staff to support and model collaborative practice and team-based care. What we have come to think of as the Toronto Model is integrated across all sites and professions and includes classroom, simulation, and practice education

A fluid flow perspective on the diagenesis of Te Aute limestones

Pliocene cool-water, bioclastic Te Aute limestones in East Coast Basin, New Zealand, accumulated either in shelfal shoal areas or about structurally shallow growth fold structures in the tectonically active accretionary forearc prism. Up to five stages of carbonate cementation are recognised, based on cement sequence-stratigraphic concepts, that formed on the seafloor during exposure of the limestones before burial, during burial, uplift, and deformation. Two principal fluid types are identified--topography-driven meteoric fluids and compaction-driven fluids. We have developed conceptual and quantitative models that attempt to relate the physical characteristics of fluid flow to the cement paragenesis. In particular, we have simulated the effects of uplift of the axial ranges bordering East Coast Basin in terms of the degree of penetration of a meteoric wedge into the basin. The dynamics of meteoric flow changed dramatically during uplift over the last 2 m.y. such that the modelled extent of the meteoric wedge is at least 40 km across the basin, and the penetration depth 1500 m or more corresponding with measured freshwater intersections in some oil wells. Cement-fluid relationships include: (1) true marine cements that precipitated in areas remote from shallow freshwater lenses; (2) pre-compaction cements that formed in shallow freshwater lenses beneath limestone "islands"; (3) post-compaction cements derived from compaction-driven flow during burial; (4) early uplift-related fracture-fill cements formed during deformation of the accretionary prism and uplift of the axial ranges; and (5) late uplift-related cements associated with uplift into a shallow meteoric regime

Countdown to 2010: Can we assess Ireland’s insect species diversity and loss?

peer-reviewedThe insects are the most diverse organisms on this planet and play an essential role in ecosystem functioning, yet we know very little about them. In light of the Convention on Biological Diversity, this paper summarises the known insect species numbers for Ireland and questions whether this is a true refl ection of our insect diversity. The total number of known species for Ireland is 11,422. Using species accumulation curves and a comparison with the British fauna, this study shows that the Irish list is incomplete and that the actual species number is much higher. However, even with a reasonable knowledge of the species in Ireland, insects are such speciose, small, and inconspicuous animals that it is diffi cult to assess species loss. It is impossible to know at one point in time the number of insect species in Ireland and, although it is useful to summarise the known number of species, it is essential that biodiversity indicators, such as the Red List Index, are developed

Proposed revision to the Federal Reserve's discount window lending programs

The Board of Governors' Regulation A currently authorizes the Federal Reserve Banks to operate three main discount window programs: adjustment credit, extended credit, and seasonal credit. On May 17, 2002, the Board published for public comment a proposed amendment to Regulation A that would establish two new discount window programs called primary credit and secondary credit as replacements for adjustment and extended credit. Primary credit would be available for very short terms, ordinarily overnight, to depository institutions that are in generally sound financial condition. Secondary credit would be available, subject to Reserve Bank approval and monitoring, for depository institutions that did not qualify for primary credit. The interest rate on primary credit would usually be above short-term market interest rates, including the federal funds rate, as opposed to the current situation in which the discount rate (the interest rate for adjustment credit) is typically below money market interest rates. Because of the above-market rate, the restrictions currently employed to limit access to adjustment credit will be unnecessary for primary credit. The primary credit program would be broadly similar to mechanisms adopted by many other major central banks to provide credit at the margin at an above-market rate.Discount window ; Regulation A: Extensions of Credit by Federal Reserve Banks

Progress toward the Synthesis of the Basiliolides and Transtaganolides: An Intramolecular Pyrone Diels−Alder Entry into a Novel Class of Natural Products

Efforts directed toward the synthesis of a basiliolide/transtaganolide model system are disclosed. A highly endo-selective intramolecular pyrone Diels−Alder (IMPDA) cycloaddition rapidly constructs the tricyclic core of the basiliolides and transtaganolides

The association among diet, dietary fiber, and bowel preparation at colonoscopy

BACKGROUND AND AIMS: Pre-colonoscopy dietary restrictions vary widely and lack evidence-based guidance. We investigated whether fiber and various other foods/macronutrients consumed during the 3 days before colonoscopy are associated with bowel preparation quality. METHODS: This was a prospective observational study among patients scheduled for outpatient colonoscopy. Patients received instructions including split-dose polyethylene glycol, avoidance of vegetables/beans 2 days before colonoscopy, and a clear liquid diet the day before colonoscopy. Two 24-hour dietary recall interviews and 1 patient-recorded food log measured dietary intake on the 3 days before colonoscopy. The Nutrition Data System for Research was used to estimate dietary exposures. Our primary outcome was the quality of bowel preparation measured by the Boston Bowel Preparation Scale (BBPS). RESULTS: We enrolled 201 patients from November 2015 to September 2016 with complete data for 168. The mean age was 59 years (standard deviation, 7 years), and 90% of colonoscopies were conducted for screening/surveillance. Only 17% and 77% of patients complied with diet restrictions 2 and 1 day(s) before colonoscopy, respectively. We found no association between foods consumed 2 and 3 days before colonoscopy and BBPS scores. However, BPPS was positively associated with intake of gelatin, and inversely associated with intake of red meat, poultry, and vegetables on the day before colonoscopy. CONCLUSIONS: Our findings support recent guidelines encouraging unrestricted diets >1 day before colonoscopy if using a split-dose bowel regimen. Furthermore, we found no evidence to restrict dietary fiber 1 day before colonoscopy. We also found evidence to promote consumption of gelatin and avoidance of red meat, poultry, and vegetables 1 day before colonoscopy.Dr Jacobson has acted as a consultant for MOTUS GI and Remedy Partners. All other authors disclosed no financial relationships relevant to this publication. Supported by NIH/NIDDK R21DK105476. (R21DK105476 - NIH/NIDDK)Accepted manuscrip

Note on paramoudra-like carbonate concretions in the Urenui Formation, North Taranaki: possible plumbing system for a Late Miocene methane seep field

A reconnaissance study of calcitic and dolomitic tubular concretions in upper slope mudstone of the Late Miocene Urenui Formation exposed along the north Taranaki coastline indicates that they have a complex diagenetic history involving different phases of carbonate cementation and likely hydrofracturing associated with build up of fluid/gas pressures. The concretions resemble classical paramoudra in the European chalk, but are not siliceous and do not have a trace fossil origin. Stable oxygen and carbon isotope data suggest that the micritic carbonate cements in the Urenui paramoudra were probably sourced primarily from ascending methane fluid/gases, and that they precipitated entirely within the host mudstone below the seafloor. We suggest the paramoudra may mark the subsurface plumbing networks of a Late Miocene cold seep system, in which case they have relevance to the evolution and migration of hydrocarbons in Taranaki Basin, at this site perhaps focussed along the Taranaki Fault. The presence of dislodged and mass-emplaced paramoudra in the axial conglomerate of channels within the Urenui mudstone suggests there could be a connection between the loci of seep field development and slope failure and canyon cutting on the Late Miocene Taranaki margin