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El Morr C.,York University | Cole C.,ForaHealthyMe.com | Perl J.,Saint Michaels Hospital
Procedia Computer Science | Year: 2014

With an aging population, the number of patients presenting with a variety of chronic diseases is increasing. Three of the biggest factors impacting the delivery of healthcare are our aging population. rising labor costs and the complexity of diseases. Patients are living longer, but they have more illnesses to manage. These factors place an additional strain on our healthcare institutions. It is imperative that new methods be employed to control the cost of managing chronic disease. This paper explains the implementation of versatile health Virtual Community for chronic disease management (VC); it describes the functionalities offered for patients with Chronic Kidney Disease (CKD). The health VC offers patients tools that empowers them to access medically validated treatment and disease management information, track and report on related medical events, invite a member of the healthcare team to virtually communicate, track and monitor patients to ensure treatment and medication adherence, and transition to home care. © 2014 The Authors. Source

Gilbert C.,A+ Network | Cherney D.Z.I.,A+ Network | Cherney D.Z.I.,University of Toronto | Parker A.B.,A+ Network | And 5 more authors.
American Journal of Physiology - Regulatory Integrative and Comparative Physiology | Year: 2015

Abnormal renal function is common in acute and chronic congestive heart failure (CHF) and is related to the severity of congestion. However, treatment of congestion often leads to worsening renal function. Our objective was to explore basal determinants of renal function and their response to hemodynamic interventions. Thirty-seven patients without CHF and 59 patients with chronic CHF (ejection fraction; 23±8%) underwent right heart catheterization, measurements of glomerular filtration rate (GFR; inulin) and renal plasma flow (RPF; para-aminohippurate), and radiotracer estimates of renal sympathetic activity. A subset (26 without, 36 with CHF) underwent acute pharmacological intervention with dobutamine or nitroprusside. We explored the relationship between baseline and drug-induced hemodynamic changes and changes in renal function. In CHF, there was an inverse relationship among right atrial mean pressure (RAM) pressure, RPF, and GFR. By contrast, mean arterial pressure (MAP), cardiac index (CI), and measures of renal sympathetic activity were not significant predictors. In those with CHF there was also an inverse relationship among the drug-induced changes in RAM as well as pulmonary artery mean pressure and the change in GFR. Changes in MAP and CI did not predict the change in GFR in those with CHF. Baseline values and changes in RAM pressure did not correlate with GFR in those without CHF. In the CHF group there was a positive correlation between RAM pressure and renal sympathetic activity. There was also an inverse relationship among RAM pressure, GFR, and RPF in patients with chronic CHF. The observation that acute reductions in RAM pressure is associated with an increase in GFR in patients with CHF has important clinical implications. © 2016 the American Physiological Society. Source

Tsang J.L.,University of Toronto | Tsang J.L.,Sunnybrook Health science Center | Parodo J.C.,Saint Michaels Hospital | Marshall J.C.,University of Toronto
Journal of Inflammation | Year: 2010

Background. Diisopropyl fluorophosphate (DFP) is a serine protease inhibitor that is widely used as an inhibitor of endogenous proteases in in vitro neutrophil studies. Its effects on neutrophil function are unclear. We sought to determine the biological effects of DFP on human neutrophil apoptosis and oxidative burst. Methods. We isolated neutrophils from healthy volunteers, incubated them with DFP (2.5 mM), and evaluated neutrophil elastase (NE) activity, neutrophil degranulation, apoptosis as reflected in hypodiploid DNA formation and exteriorization of phosphatidylserine (PS), processing and activity of caspases-3 and -8, oxidative burst activity and hydrogen peroxide release. Results. Consistent with its activity as a serine protease inhibitor, DFP significantly inhibited NE activity but not the degranulation of azurophilic granules. DFP inhibited constitutive neutrophil apoptosis as reflected in DNA fragmentation, and the processing and activity of caspases-3 and -8. DFP also inhibited priming of neutrophils for oxidative burst activity and hydrogen peroxide release. However, DFP enhanced the exteriorization of PS in a dose-dependent manner. Conclusion. We conclude that DFP exerts significant effects on neutrophil inflammatory function that may confound the interpretation of studies that use it for its antiprotease activity. We further conclude that endogenous proteases play a role in the biology of constitutive neutrophil apoptosis. © 2010 Tsang et al. Source

Colton P.A.,A+ Network | Dang K.,Saint Michaels Hospital | Teshima J.,Sunnybrook Health science Center | Lofchy J.,A+ Network
Academic Psychiatry | Year: 2013

Background/Objective: A curriculum renewal of the third-year psychiatry clerkship rotation at University of Toronto Medical School resulted in a shift from case-based, small-group teaching at multiple teaching sites to the delivery of core material in a larger-group format. The authors examine the effects of this change in curriculum delivery. Method: Student examination performance and student evaluations of the clerkship rotation and teaching were compared for the years before and after adoption of the updated, larger-group format curriculum. Results: Student examination performance was unchanged, comparing those who participated in small-group seminars versus those receiving larger-group core teaching. Student evaluations of the curriculum as a whole and of the core teaching were also unchanged, other than more negative evaluation of the course organization in the year immediately after implementation of the new curriculum. Conclusions: Delivering core curriculumin larger- versus smallergroup format did not have any discernible effect on student psychiatry clerkship performance, and overall student assessment of the rotation remained largely positive. The involvement of highlyrated teachers and the higher number of uninterrupted clinical days may balance out with the trend for students to generally prefer small-group to larger-group learning. Ongoing evaluation and refinement of the psychiatry clerkship experience and core curriculum will be crucial to continued assurance of a high-quality learning experience for our medical students. Copyright © 2013 Academic Psychiatry. Source

Lupia E.,University of Turin | Goffi A.,Saint Michaels Hospital | Bosco O.,University of Turin | Montrucchio G.,University of Turin
Mediators of Inflammation | Year: 2012

Thrombopoietin (TPO) is a humoral growth factor originally identified for its ability to stimulate the proliferation and differentiation of megakaryocytes. In addition to its actions on thrombopoiesis, TPO directly modulates the homeostatic potential of mature platelets by influencing their response to several stimuli. In particular, TPO does not induce platelet aggregation per se but is able to enhance platelet aggregation in response to different agonists (priming effect). Our research group was actively involved, in the last years, in characterizing the effects of TPO in several human critical diseases. In particular, we found that TPO enhances platelet activation and monocyte-platelet interaction in patients with unstable angina, chronic cigarette smokers, and patients with burn injury and burn injury complicated with sepsis. Moreover, we showed that TPO negatively modulates myocardial contractility by stimulating its receptor c-Mpl on cardiomyocytes and the subsequent production of NO, and it mediates the cardiodepressant activity exerted in vitro by serum of septic shock patients by cooperating with TNF- and IL-1. This paper will summarize the most recent results obtained by our research group on the pathogenic role of elevated TPO levels in these diseases and discuss them together with other recently published important studies on this topic. Copyright 2012 Enrico Lupia et al. Source

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