Over the last two decades,the dogma that cell fate is immutable has been increasingly challenged,with important implications for regenerative medicine.The brea kth rough discovery that induced pluripotent stem cells c...Over the last two decades,the dogma that cell fate is immutable has been increasingly challenged,with important implications for regenerative medicine.The brea kth rough discovery that induced pluripotent stem cells could be generated from adult mouse fibroblasts is powerful proof that cell fate can be changed.An exciting extension of the discovery of cell fate impermanence is the direct cellular reprogram ming hypothesis-that terminally differentiated cells can be reprogrammed into other adult cell fates without first passing through a stem cell state.展开更多
Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adul...Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adults with a CI may negatively influence the attitudes and job satisfaction of healthcare practitioners working with this population. The current study is a part of a larger intervention study allowing patients with CI following a hip fracture access to rehabilitation care and implementing a patient-centred model to facilitate caring for this new population. This new model required a substantial change in the skillset and knowledge of healthcare practitioners. The focus of this study was to explore the impact on the healthcare practitioners of adopting this new model for providing care to older adults with a CI following a hip fracture. The attitudes, dementia knowledge, job satisfaction, and work stress of healthcare practitioners were the focus of evaluation. Key study findings showed that stress due to relationships with coworkers, workloads and scheduling, and the physical design and conditions at work were moderated post-intervention. Staff responses also improved for job satisfaction, biomedical knowledge of dementia, and degree of hopefulness about dementia. Although we cannot state conclusively that the our model was solely responsible for all the staff improvements observed post-intervention, our findings provide further support to the argument that patients with CI should be allowed access to rehabilitation care. Rehabilitation units need to provide education that utilizes a person-centred approach accepting of patients with CI, and focuses on areas that can bolster staff’s positive, dementia-sensitive attitudes. Ultimately, the aim is to create a culture that provides the highest standard of care for all patients, reduces work-related stress, increases job satisfaction, and leads to the highest quality of life for patients during and after rehabilitation.展开更多
The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic revi...The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.展开更多
Reconstitution of complex multi-tissue organs is one of the most impressive feats of biology and is observed across regeneration-competent vertebrate species,including teleost fish(e.g.,zebrafish),urodeles(e.g.,axolot...Reconstitution of complex multi-tissue organs is one of the most impressive feats of biology and is observed across regeneration-competent vertebrate species,including teleost fish(e.g.,zebrafish),urodeles(e.g.,axolotls and newts),and some lizards.Regenerative ability within these species ranges from muscle(including cardiac),skeletal structures,to complex systems such as the brain,spinal cord and parts of the eye which are all capable of structural and functional repair following injury(Tanaka and Ferretti,2009).In stark contrast,re-establishment of multi-tissue structures is very rarely observed following embryogenesis in regeneration-incompetent mammals.Regrowth of digit tips is the most dramatic example of mammalian regeneration,but pales in comparison to other species in the animal kingdom.Undoubtedly,a complete recapitulation of complex organs or structures in mammals will remain out of reach for a considerable time;however,an improved understanding of regenerat i ve mechanisms would likely enhance the development of novel regenerative medicine strategies.Here we focus on the diversity and commonalities of stem cells,which could underlie complex tissue regeneration.展开更多
The Registered Nurses Association of Ontario Healthy Work Environments Best Practice Guideline recommends that employers promote safe, healthy workplaces. Healthy workplaces include addressing the unique needs of nurs...The Registered Nurses Association of Ontario Healthy Work Environments Best Practice Guideline recommends that employers promote safe, healthy workplaces. Healthy workplaces include addressing the unique needs of nurses who work while pregnant. The purpose of this descriptive study, summarizing information from 120 pregnancies reported by 95 nurses, was to determine if the workload of obstetrical nurses was associated with negative pregnancy outcomes, including preterm delivery and birth weight. Full-time obstetrical nursing work is a predictor of reduced birth weight, but not of preterm birth when compared to outcomes of obstetrical nurses working part time. One third of nurses reported pregnancy complications and most nurses experienced work-related and personal stress. Further research evaluating work modifications during pregnancy is indicated to improve birth outcomes.展开更多
基金supported by Canada First Research Excellence Fund,Medicine by Design(to CMM)。
文摘Over the last two decades,the dogma that cell fate is immutable has been increasingly challenged,with important implications for regenerative medicine.The brea kth rough discovery that induced pluripotent stem cells could be generated from adult mouse fibroblasts is powerful proof that cell fate can be changed.An exciting extension of the discovery of cell fate impermanence is the direct cellular reprogram ming hypothesis-that terminally differentiated cells can be reprogrammed into other adult cell fates without first passing through a stem cell state.
文摘Until recently, older adults with a cognitive impairment (CI) who experienced a hip fracture were filtered from being admitted into active rehabilitation units. The increased complexity of care required for older adults with a CI may negatively influence the attitudes and job satisfaction of healthcare practitioners working with this population. The current study is a part of a larger intervention study allowing patients with CI following a hip fracture access to rehabilitation care and implementing a patient-centred model to facilitate caring for this new population. This new model required a substantial change in the skillset and knowledge of healthcare practitioners. The focus of this study was to explore the impact on the healthcare practitioners of adopting this new model for providing care to older adults with a CI following a hip fracture. The attitudes, dementia knowledge, job satisfaction, and work stress of healthcare practitioners were the focus of evaluation. Key study findings showed that stress due to relationships with coworkers, workloads and scheduling, and the physical design and conditions at work were moderated post-intervention. Staff responses also improved for job satisfaction, biomedical knowledge of dementia, and degree of hopefulness about dementia. Although we cannot state conclusively that the our model was solely responsible for all the staff improvements observed post-intervention, our findings provide further support to the argument that patients with CI should be allowed access to rehabilitation care. Rehabilitation units need to provide education that utilizes a person-centred approach accepting of patients with CI, and focuses on areas that can bolster staff’s positive, dementia-sensitive attitudes. Ultimately, the aim is to create a culture that provides the highest standard of care for all patients, reduces work-related stress, increases job satisfaction, and leads to the highest quality of life for patients during and after rehabilitation.
文摘The objective of this guideline is to outline the role of magnetic resonance imaging(MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury(SCI).Methods A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI.This review focused on longitudinal studies that controlled for baseline neurologic status.A multidisciplinary Guideline Development Group(GDG) used this information,their clinical expertise,and patient input to develop recommendations on the use of MRI for SCI patients.Based on GRADE(Grading of Recommendation,Assessment,Development and Evaluation),a strong recommendation is worded as " we recommend," whereas a weaker recommendation is indicated by "we suggest." Results Based on the limited available evidence and the clinical expertise of the GDG,our recommendations were:(1) "We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention,when feasible,to facilitate improved clinical decision-making"(quality of evidence,very low) and(2) "We suggest that MRI should be performed in adult patients in the acute period following SCI,before or after surgical intervention,to improve prediction of neurologic outcome "(quality of evidence,low).Conclusions These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.
文摘Reconstitution of complex multi-tissue organs is one of the most impressive feats of biology and is observed across regeneration-competent vertebrate species,including teleost fish(e.g.,zebrafish),urodeles(e.g.,axolotls and newts),and some lizards.Regenerative ability within these species ranges from muscle(including cardiac),skeletal structures,to complex systems such as the brain,spinal cord and parts of the eye which are all capable of structural and functional repair following injury(Tanaka and Ferretti,2009).In stark contrast,re-establishment of multi-tissue structures is very rarely observed following embryogenesis in regeneration-incompetent mammals.Regrowth of digit tips is the most dramatic example of mammalian regeneration,but pales in comparison to other species in the animal kingdom.Undoubtedly,a complete recapitulation of complex organs or structures in mammals will remain out of reach for a considerable time;however,an improved understanding of regenerat i ve mechanisms would likely enhance the development of novel regenerative medicine strategies.Here we focus on the diversity and commonalities of stem cells,which could underlie complex tissue regeneration.
文摘The Registered Nurses Association of Ontario Healthy Work Environments Best Practice Guideline recommends that employers promote safe, healthy workplaces. Healthy workplaces include addressing the unique needs of nurses who work while pregnant. The purpose of this descriptive study, summarizing information from 120 pregnancies reported by 95 nurses, was to determine if the workload of obstetrical nurses was associated with negative pregnancy outcomes, including preterm delivery and birth weight. Full-time obstetrical nursing work is a predictor of reduced birth weight, but not of preterm birth when compared to outcomes of obstetrical nurses working part time. One third of nurses reported pregnancy complications and most nurses experienced work-related and personal stress. Further research evaluating work modifications during pregnancy is indicated to improve birth outcomes.
