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

Cognitive and behavioral improvement in adults with fragile X syndrome treated with metformin-two cases.

BackgroundThe majority of individuals with fragile X syndrome (FXS) have intellectual disability, behavioral problems, autism, and language deficits. IQ typically declines with age in boys with the full mutation. The results of preclinical studies demonstrated that metformin, a biguanide used to treat type 2 diabetes, rescues multiple phenotypes of FXS in both Drosophila and mouse models. Preliminary studies of patients with FXS demonstrated improvements in behavior.MethodsHere, we present two cases of individuals who have been treated with metformin clinically for one year.ResultsBoth patients demonstrated significant cognitive and behavioral improvements. They also improved eating habits and normalization of their weight percentiles.ConclusionMetformin may be a candidate drug for treatment of several types of symptoms in individuals with FXS

Circulating MicroRNA Profiling in Cancer Biomarker Discovery

MicroRNAs (miRNAs) are a class of small non-coding RNA molecules of approximately 22 nucleotides that regulate gene expression at the post-transcriptional level. Alterations in miRNA expression patterns correlate with a wide spectrum of pathological conditions, including cancer. miRNA profiling was mostly performed, in solid tissues, obtained by invasive diagnostic procedures. However, miRNAs in biofluids, such as serum and plasma, show high stability resulting from the formation of complexes with specific protein or incorporation within circulating exosomes or other microvesicles. Circulating miRNAs could be reliable biomarkers for early-stage cancer diagnosis, prognosis and response to therapy. In this chapter, we analyze the major pre-analytical and analytical challenges in experimental design for circulating miRNA detection, focusing on exosome fraction and microarray-based approach

Pasture-based swine management: behaviour and performances of growing-finishing pigs

A pasture-based swine management (PBSM) trial was conducted in Piemonte (N-W Italy) to study the performances and the carcass yield of 16 hybrid pigs (8 castrated males and 8 females; average initial weight: 90 kg). Animals were allowed to forage pea, clover, beet and alfalfa pastures for 170 days in a crop-pasture rotation on different paddocks. A concentrate was fed to supply 50% of estimated energy requirements. Forage dry matter intake (DMI) ranged from 0.32 kg/day (alfalfa) to 2.85 kg/day (pea), depending on the period and forage type. Pigs were weighted every 30 days and at slaughtering; average daily gain (ADG) was 0.29 kg. The stocking rate (SR) ranged from 109 kg/ha LW (clover) to 2347 kg/ha LW (pea). Data collected at slaughtering (average final weight: 141 kg) were: hot carcass weight and yield, lean and fat cuts weight, backfat thickness, pH45 and pH24. The statistical analysis (ANOVA of SPSS) did not show differences between males and females. Results showed that PBSM should be especially appealing to limited-resource farmers due to low inputs needed; pasture can be used to replace 50% of the nutritional needs, helping to save on grain costs, without affecting carcass characteristics

Fragile X- associated Neuropsychiatric Disorders: A Case Report

Mutations in the Fragile X Mental Retardation 1 (FMR1) gene create a spectrum of developmental disorders in children in addition to neurodegenerative problems in older populations. Two types of mutations are recognized in the FMR1 gene. The full mutation (\u3e200 CGG repeats) in the FMR1 gene leads to Fragile X Syndrome which is the most common inherited cause of intellectual disability and autism, while the premutation (55 to 200 CGG repeats) identified among carriers leads to a range of problems linked to elevated levels of the FMR1 mRNA leading to mRNA toxicity and occasionally mildly deficient FMRP levels. Two disorders among premutation carriers have been recognized namely: the Fragile X-associated Primary Ovarian Insufficiency (FXPOI) and Fragile X-associated Tremor/Ataxia Syndrome (FXTAS). Recently, in order to recognize a group of associated disorders commonly found in premutation carriers and extensively reported in co-morbidities studies, a new distinctive name was proposed: Fragile X-associated Neuropsychiatric Disorders (FXAND). This paper will present a case report of a female premutation carrier who has encountered predominantly psychiatric problems, but also chronic pain and sleep disturbances consistent with FXAND

Nutritive value and energy content of the straw of selected Vicia L. taxa from Tunisia

The chemical composition and energy value of straws of <em>Vicia sativa</em> L. (varieties Languedoc and Mghila, and subspecies <em>amphicarpa</em>) and <em>Vicia villosa</em> Roth. (variety Sejenane and accession 2565) were investigated. The plants were grown in a Mediterranean environment, under identical environmental conditions. Total digestible nutrients (TDN) and energy values (digestible energy, metabolisable energy, and net energy for lactation) were estimated according to the equations developed by the 2001 Dairy National Research Council. Both ether extract (EE) or total fatty acids (FA) amounts, and digestible neutral detergent fibre (dNDF) calculated from chemical analysis or measured using a 48-hour rumen <em>in vitro</em> assay were used for calculations. Significant differences were observed in the chemical composition and energy value of the straws of the considered <em>V. sativa</em> and <em>V. villosa</em> varieties. Within the same variety, the TDN was similar using either EE or FA values for calculation. The energy resulted largely dependent on the dNDF values. Energy was higher when <em>in vitro</em> dNDF was used for calculation in low-NDF straw samples, while the opposite occurred for high-NDF samples

BRCA1/2 genetic background-based therapeutic tailoring of human ovarian cancer: hope or reality?

Ovarian epithelial tumors are an hallmark of hereditary cancer syndromes which are related to the germ-line inheritance of cancer predisposing mutations in BRCA1 and BRCA2 genes. Although these genes have been associated with multiple different physiologic functions, they share an important role in DNA repair mechanisms and therefore in the whole genomic integrity control. These findings have risen a variety of issues in terms of treatment and prevention of breast and ovarian tumors arising in this context. Enhanced sensitivity to platinum-based anticancer drugs has been related to BRCA1/2 functional loss. Retrospective studies disclosed differential chemosensitivity profiles of BRCA1/2-related as compared to "sporadic" ovarian cancer and led to the identification of a "BRCA-ness" phenotype of ovarian cancer, which includes inherited BRCA1/2 germ-line mutations, a serous high grade histology highly sensitive to platinum derivatives. Molecularly-based tailored treatments of human tumors are an emerging issue in the "era" of molecular targeted drugs and molecular profiling technologies. We will critically discuss if the genetic background of ovarian cancer can indeed represent a determinant issue for decision making in the treatment selection and how the provocative preclinical findings might be translated in the therapeutic scenario. The presently available preclinical and clinical evidence clearly indicates that genetic background has an emerging role in treatment individualization for ovarian cancer patients

Sleep hygiene impacts on episodic memories in young and older adults during quarantine by Covid-19: preliminary results

Sleep benefits off-line memory consolidation. Due to quarantine by Covid-19, sleep routines and sleep quality were affected. Preliminary results from our Lab showed that episodic memory formation is impaired by emotional variables, such as anxiety and depression. We hypothesize that sleep hygiene during quarantine positively impacts memory processes and emotional variables. To test this, we perform a 21-day study. Young and older participants were trained on the episodic memory task (video of neutral content). On day 7 they were tested and half of them began a sleep hygiene program. On day 14, participants were trained in a new episodic task and were tested on day 21. We found that young and older adults that received the sleep hygiene treatment had a positive impact on memory performance. Furthermore, older adults had better performance in memory recognition than young adults independently of the hygiene treatment. Moreover, older adults that received the sleep hygiene treatment showed a positive correlation between the total amount of sleep hygiene activities and the amount of correct recognition as well as a negative correlation with false recognition. We did not found a significant effect on emotional variables. These results demonstrate that sleep hygiene can be an effective tool for young and older adults to improve memory, however one-week treatment is not enough to induce emotional improvements.Fil: Tassone, Leonela Magali. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Tecnológico de Buenos Aires; ArgentinaFil: Moyano, Malen Daiana. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Tecnológico de Buenos Aires; ArgentinaFil: Solferino, C.. Instituto Tecnológico de Buenos Aires; ArgentinaFil: Feldberg, Carolina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurociencias Buenos Aires S. A.; ArgentinaFil: Tartaglini, Maria Florencia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto de Neurociencias Buenos Aires S. A.; ArgentinaFil: Brusco, I.. Centro de Neuropsiquiatría y Neurología de la Conducta; ArgentinaFil: Forcato, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Tecnológico de Buenos Aires; ArgentinaXXXV Annual Meeting of the Argentinian Society for Neuroscience ResearchCiudad Autónoma de Buenos AiresArgentinaSociedad Argentina de Investigación en Neurociencia