Bringing innovation to stroke care: development of a comprehensive stroke unit

Much work has been done in the past 10 years to research and document best practices in stroke care along the continuum of care. The challenge now for stroke care practitioners is to turn those best practices into reality in a clinical setting. In spite of a general understanding and acceptance of the benefits to the patient, an organization's culture and limited access to resources can frustrate our best efforts to introduce best practices at the bedside. Trillium Health Centre, a community hospital serving a diverse community of more than one million people, has turned best practice stroke care guidelines into reality by developing a 14-bed comprehensive stroke unit. This innovative approach to care uses specialized stroke teams, an interdisciplinary approach to care, and a single unit where the patient remains in the same bed throughout the acute and rehabilitation stages of care. Commitment to the new delivery model by formal leaders, informal leaders, and front-line staff and a supportive organizational structure contributed to an expedited and successful implementation. All changes were implemented without an increase in the overall resources assigned to the unit. Early results show that the average length of stay is shorter than the national standard and that provider and patient satisfaction have improved.     

The effect of stromal components on the modulation of the phenotype of human bronchial epithelial cells in 3D culture

The stroma plays an important role in the development and progression of human diseases. Pulmonary diseases such as asthma, fibrosis and cancer are thought to be the result of altered communications between the epithelial and stromal tissue compartments. In order to study these epithelial-mesenchymal interactions, we developed a three dimensional (3D) in vitro model of the human airway that mimics bronchial morphology and function. This model consists of a type-I collagen matrix, normal human fetal lung fibroblasts (IMR-90) or primary human adult lung cancer-associated fibroblasts (LuCAFs), and a surface epithelium of normal human bronchial epithelial cells (HBECs). When cultured at an air-liquid interface (ALI), the epithelial component generated a well-differentiated pseudo-stratified bronchial epithelium that contained basal, ciliated, and non-ciliated (secretory) epithelial cells. IMR-90 and LuCAFs differentially altered the phenotype of HBECs in distinct ways. While IMR-90 permitted HBECs to form a typical respiratory surface epithelium, LuCAFs promoted HBECs to invade the collagen gel forming both epithelial nodules and cysts, suggesting that LuCAFs may alter the HBEC phenotype by modifying biomechanical signals conveyed through the extracellular matrix (ECM). Furthermore, LuCAFs secreted soluble factors that induced HBECs to express genes associated with immune responses, apoptosis, mitosis, cell survival, differentiation and cancer.     

Enhanced 5-F.U. mortality in rats eating definded formula diets

Rats eating nutritionally adequate defined-formula diets (D.F.D) before and following lethal i.p. injection of 5-fluorouracil exhibit increased mortality and shorter survival time than rats eating conventional Purina rat chow. Neither the presence of proteins in hydrolyzed form nor the nitrogen level in the D.F.D appear to be the crucial factor of enhanced lethality. The possible mechanisms and implications of the phenomenon are discussed.     

Saving costs using an ounce of prevention: introduction of a regional stroke prevention clinic

Trillium Health Centre (THC) is one of Canada's largest community hospitals and a regional provider of tertiary-level cardiac, neuroscience, and orthopedic care. In 2001, it was named one of nine Regional Stroke Centres in Ontario, with a mandate to coordinate stroke services across the continuum of care in keeping with best practices in the west Greater Toronto Area (GTA). Within its role as a Regional Stroke Centre, THC has successfully implemented an innovative approach to the delivery of stroke prevention services in its regional catchment area. Building on best practices, it has introduced a specialized and interdisciplinary team to provide timely and effective primary and secondary prevention services. The rapid growth in utilization to more than 2000 patients in the last fiscal year (2004-2005), suggests that the clinic is meeting a real need in the community for stroke prevention services. Many of these patients now benefit from appropriate medical management, stroke awareness education, lifestyle counselling, and expedited referrals to other specialists. The Regional Stroke Prevention Clinic (RSPC) may be the first step in preventing a stroke, thus avoiding the social costs to people with strokes and their families, and the financial burden on the health care system.     

The Role of Nitrogen Availability for the Salt-Tolerance of Two Different Varieties of Durum Wheat

Salt stress tolerance of durum wheat was assessed in control and 200 and 300 mM NaCl-exposed seed of two cultivars (BidiAP4 and Azizi). These salt treatments were accompanied by different levels of nitrate (Ca(NO₃)₂) added to the media (0.1, 3, 10 mM). The data showed that NaCl stress increased Na⁺ and Cl^? contents and lowered K⁺ and NO₃ ^? levels in seeds of BidiAP4 cultivar. In Azizi seeds exposed to NaCl, Na⁺ and K⁺ were highly accumulated while low levels of NO₃ ^? and Cl^? were detected. Those findings highlight the difference in the salt stress tolerance of these two durum wheat cultivars also depending on nitrogen (N) availability, Azizi cultivar being less sensitive to NaCl treatment than BidiAP4. These data also suggested a relationship between salt tolerance capacity and enhancement or maintenance of nitrogen and carbon metabolisms enzyme activity.     

Combination of 60Co gamma-radiation, misonidazole, and maltose tetrapalmitate in the treatment of Dunning prostatic tumor in the rat

Maltose tetrapalmitate (MTP), a synthetic nontoxic immunoadjuvant, the radiosensitizer misonidazole (MISO), and 60Co gamma-radiation, alone or in combination, were used in the management of Dunning prostatic tumor in the rat. Nine groups of 10 rats each were used to assess the efficacy of various therapeutic modalities. Tumor growth rates and animal survival times were determined for each group. Radiation was more effective when combined with MTP, but the adjuvant must be present when radiation is given for synergism to occur. MISO was as effective as MTP when used with radiation, but combining them cancels out their individual effects. In a clinical situation it would be advantageous to use separately the synergisms existing between MISO and radiation on the one hand and MTP and radiation on the other hand.     

Effects of single and combined maltose tetrapalmitate immunotherapy, cyclophosphamide chemotherapy and radiotherapy on ethyl carbamate accelerated primary lung cancer in A/J mice

A/J mice were given ethyl carbamate to accelerate and to raise to 100 percent the incidence of lung tumours at 34 weeks (day 237) of age. The animals were then divided into groups which received the following treatments: group 1, no treatment; group 2, MTP alone; group 3, radiotherapy alone; group 4, cyclophosphamide alone; group 5, radiotherapy + MTP; group 6, MTP + cyclophosphamide; group 7, radiotherapy followed by cyclophosphamide and group 8, MTP and radiotherapy together followed by MTP and cyclophosphamide. Except for radiotherapy, which was given for 5 consecutive days, MTP and cyclophosphamide were continued till the death of the animals. The treatment efficacies were evaluated by the number and size of tumour nodules, taking into consideration the survival time of the animal. Animals in groups receiving cyclophosphamide died earlier (between days 290 and 315) due to its toxic effects, and half of the radiotherapy-MTP were sacrificed at day 314 for comparison. Although cyclophosphamide alone and radiotherapy plus cyclophosphamide demonstrated antitumour activity, the number of tumour nodules and the nodule diameter were reduced most effectively in group 8 (receiving MTP, radiotherapy and cyclophosphamide). Among the animals in the non-cyclophosphamide group, radiotherapy alone was ineffective. MTP given before and after radiotherapy (group 5) kept tumour volume in control although this group died suddenly. The animals receiving only MTP died between day 430 and 470. The number of tumour nodules and the nodule diameter in the MTP group were, however, significantly reduced when compared to controls or radiotherapy group animals dying at or near the same time.