Adapting Our SCOPE: Lessons Learned from Spreading and Scaling Efforts to Integrate Care.

SCOPE (Seamless Care Optimizing the Patient Experience) launched in 2012 to support primary care in downtown Toronto with live navigation and rapid access to acute and community care resources for primary care providers (PCPs) and their patients. Ten years later, over 1,800 PCPs across Ontario have signed up for SCOPE and over 48,000 interactions in the form of e-mail, fax, phone and secure messaging have been conducted. Case examples illustrate the ways in which SCOPE has been adapted across a range of Ontario Health Teams, including under-resourced, small urban and rural sites. Primary care engagement, change management strategies and flexibility to meet the individual needs of each site have been key factors in the successful spread and scale of SCOPE's services.

Simvastatin Promotes Cardiac Myocyte Relaxation in Association with Phosphorylation of Troponin I.

The number of people taking statins is set to increase across the globe due to recent changes in prescription guidelines. For example, half the US population over 40 is now eligible for these drugs, whether they have high serum cholesterol or not. With such development in policy comes a stronger need for understanding statins' myriad of effects. Surprisingly little is known about possible direct actions of statins on cardiac myocytes, although claims of a direct myocardial toxicity have been made. Here, we determine the impact of simvastatin administration (40 mg/kg/day) for 2 weeks in normocholesterolemic rats on cardiac myocyte contractile function and identify an underlying mechanism. Under basal conditions, statin treatment increased the time to half (t0.5) relaxation without any effect on the magnitude of shortening, or the magnitude/kinetics of the [Ca2+]i transient. Enhanced myocyte lusitropy could be explained by a corresponding increase in phosphorylation of troponin I (TnI) at Ser23,24. Statin treatment increased expression of eNOS and Ser1177 phosphorylated eNOS, decreased expression of the NOS-inhibitory proteins caveolins 1 and 3, and increased (P = 0.06) NO metabolites, consistent with enhanced NO production. It is well-established that NO stimulates protein kinase G, one of the effectors of TnI phosphorylation at Ser23,24. Trends for parallel changes in phospho-TnI, phospho-eNOS and caveolin 1 expression were seen in atrial muscle from patients taking statins. Our data are consistent with a mechanism whereby chronic statin treatment enhances TnI phosphorylation and myocyte lusitropy through increased NO bioavailability. We see no evidence of impaired function with statin treatment; the changes we document at the level of the cardiac myocyte should facilitate diastolic filling and cardiac performance.

Releasing the GENIE and Other Tips for Life Sciences Teachers.

This article was migrated. The article was marked as recommended. This paper describes practical tips and tools for delivering life sciences teaching, it is based on the authors' experiences at Norwich Medical School (NMS), which opened in 2002 at the University of East Anglia. The inaugural medical curriculum, including its ethos and how it is perceived by staff and students, have all been described previously.⁽¹â»³â¾ Our 5 year medical degree at NMS is a modular, systems-based programme that integrates theory and clinical practice from the beginning. We use problem based learning (PBL) but teaching is also delivered via clinical placement; structured and simulated patient teaching; and via formal lectures and workshops. Core social science themes and life science themes run longitudinally through the course and spiral delivery of learning outcomes allows students to re-visit our themes, and particular topics, with increasing complexity. We offer ten tips here, about delivering the curricula for genetics, pharmacology, and prescribing. One challenge that we face, with a modular degree programme, is that we meet our students intermittently and throughout their years of study, and our science curriculum has been developed in response to this.

[Améliorer l'expérience des patients par la personnalisation des services de santé].

De nombreux leaders trouvent difficile de mobiliser les patients, dont les attentes envers les services de santé exigent désormais une approche plus personnalisée. Le présent article porte sur les tendances de consommation qui influent sur la mobilisation et l'autonomisation des patients à l'égard des technologies numériques. Éclairés par les tendances de consommation et de santé en population susceptibles de personnaliser les services de santé, les leaders peuvent adopter trois stratégies pour renforcer l'expérience des patients : mettre davantage l'accent sur la santé et le bien-être personnels, amorcer un virage vers des soins de santé personnalisés plutôt que normalisés et faciliter la démocratisation de l'information en matière de santé.

Enhancing patient experience through personalization of health services.

Patient engagement is a challenge many leaders are facing, as consumer expectations of health services demand a more personalized approach to care. This article examines consumer trends that are influencing patient engagement and empowerment relative to the use of digital technologies. Informed by consumer and population health trends that can personalize health services, three strategies leaders can engage to strengthen patient experience include placing greater focus on personal health and wellness, shifting towards personalized rather than standardized healthcare, and facilitating the democratization of healthcare information.

Reverse innovation: an opportunity for strengthening health systems.

BACKGROUND: Canada, when compared to other OECD countries, ranks poorly with respect to innovation and innovation adoption while struggling with increasing health system costs. As a result of its failure to innovate, the Canadian health system will struggle to meet the needs and demands of both current and future populations. The purpose of this initiative was to explore if a competition-based reverse innovation challenge could mobilize and stimulate current and future leaders to identify and lead potential reverse innovation projects that address health system challenges in Canada. METHODS: An open call for applications took place over a 4-month period. Applicants were enticed to submit to the competition with a $50,000 prize for the top submission to finance their project. Leaders from a wide cross-section of sectors collectively developed evaluation criteria and graded the submissions. The criteria evaluated: proof of concept, potential value, financial impact, feasibility, and scalability as well as the use of prize money and innovation team. RESULTS: The competition received 12 submissions from across Canada that identified potential reverse innovations from 18 unique geographical locations that were considered developing and/or emerging markets. The various submissions addressed health system challenges relating to education, mobile health, aboriginal health, immigrant health, seniors health and women's health and wellness. Of the original 12 submissions, 5 finalists were chosen and publically profiled, and 1 was chosen to receive the top prize. CONCLUSIONS: The results of this initiative demonstrate that a competition that is targeted to reverse innovation does have the potential to mobilize and stimulate leaders to identify reverse innovations that have the potential for system level impact. The competition also provided important insights into the capacity of Canadian students, health care providers, entrepreneurs, and innovators to propose and implement reverse innovation in the context of the Canadian health system.