Genetics of asthma: University of Toronto. The University of Toronto Genetics of Asthma Research Group.
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Asthma↗
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Genetics of asthma: the University of Toronto Program. University of Toronto Genetics of Asthma Research Group.
In 1991, we initiated a study to identify susceptibility gene(s) predisposing individuals to the development of asthma. Our strategy was to focus on the collection of inbred populations because (1) they are likely to exhibit greater homogeneity than outbred populations, potentially important in multigenic diseases, (2) there may be fewer genes explaining the asthma diathesis in families with a "founder effect," (3) it is possible to follow the pattern of inheritance more closely, and (4) environmental factors are likely to be more uniform in geographically isolated poulations. We have identified, and in some cases collected data on inbred and/or isolated populations in Brazil, China, Easter Island, Israel, and Tristan da Cunha. We have completed a genome-wide scan on samples from Tristan da Cunha based on a coverage of approximately 20 cM between markers. In addition, we have collected hundreds of outbred individuals from Canada; these data have been helpful in narrowing a linked region based on the transmission/disequilibrium test.
Adult↗
Gold Award. A multifaceted program for preventing and treating eating disorders. Programme for Eating Disorders, Department of Psychiatry, The Toronto Hospital, University of Toronto.
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Anorexia Nervosa↗
The first 1000 coronary artery repair operations in Toronto. The University of Toronto interhospital cardiovascular surgery group.
The present status of the aortocoronary bypass procedure is described in general terms by a review of the first 1040 patients who received this operation in Toronto, before November 15, 1973. The operative risk was related to the status of the left ventricular function. In those with fair or good ventricular function the risk of hospital mortality was less than 3% in the entire series and less than 2% in the past year. Advances in investigative and surgical techniques have allowed this operation to become an increasingly safe, effective and recommended procedure for patients suffering from medically intractable angina pectoris. The operation has been of great benefit to such individuals. In addition it has been an effective stimulus to research and development in Canadian cardiology and cardiovascular surgery.
Adult↗
An evaluation of the role of omentopexy and of early perioperative corticosteroid administration in clinical lung transplantation. The University of Toronto and Washington University Lung Transplant Programs.
Early success in clinical lung transplantation was believed due in part to the technique of bronchial anastomosis, routine bronchial omentopexy, and avoidance of early postoperative corticosteroid therapy. A recent 16-month consecutive experience at the University of Toronto and Washington University with single or bilateral lung transplantation was compared to study the current short-term effect of these perioperative strategies. At the University of Toronto, of 37 patients undergoing lung transplantation, 30 (group I) had telescoped bronchial anastomoses, coverage of the bronchus with local tissue only (no omentopexy), and routine perioperative corticosteroid administration. At Washington University, of 50 patients having lung transplantation, 44 (group II) had end-to-end bronchial anastomoses wrapped in omentum and received no routine perioperative corticosteroid. In group I, septic lung disease was the most frequent indication (14 of 29 patients), whereas in group II obstructive lung disease was the most frequently encountered condition (24 of 44 patients). Sepsis accounted for three of five early deaths in group I (all due to resistant Pseudomonas cepacia infection in recipients who had cystic fibrosis) and for two of four perioperative deaths in group II (one Pseudomonas, and Candida). In group I, cytomegalovirus prophylaxis was administered to all patients except recipients negative for cytomegalovirus receiving grafts from donors also negative for cytomegalovirus. Cytomegalovirus infection requiring treatment was encountered in 5 of 30 patients in group I in comparison with 23 of 44 recipients in group II where only D+ and R- mismatches received prophylaxis. Routine omentopexy is not essential for successful lung transplantation. Early postoperative corticosteroids do not impair airway healing, but neither do these agents appear to protect against acute rejection episodes. While routine corticosteroids do not predispose the recipient to cytomegalovirus infection, their use may increase the likelihood of postoperative bacterial sepsis.
Adolescent↗
Visiting elective students at the University of Toronto from the Korea University Medical College.
OBJECTIVES: The main goal of the international elective programme was to provide the Korean students with a cross-cultural educational environment. DESIGN: This programme was carried out on a voluntary basis during the summer vacation, rotating students through various clinical divisions in the teaching hospital. SETTING: The University of Toronto. SUBJECTS: Medical students from the Korea University Medical College. RESULTS: The students found the student-teacher relationship to be much more open and liberal. Due to a different curricular structure, the Canadians have better clinical skills and problem-solving abilities in real clinical settings. The cultural differences perceived by the students during the elective programme led them to believe that educational reform in Korea imperatively requires curricular change, but more importantly, a change in our traditional psychological and behavioural traits which derive from Confucianism. CONCLUSIONS: Extreme politeness, passiveness and blind respect for teachers, which are encouraged by Confucianism, are not effective in higher education. All the elective students, as well as the Canadian preceptors, believe that this programme is an invaluable asset.
Cross-Cultural Comparison↗
Gold award: providing psychiatric care and consultation in remote Indian villages--Department of Psychiatry, University of Toronto, Toronto, Ontario.
Faculty of the University of Toronto department of psychiatry take several trips a year to remote Indian villages in northwestern Ontario to deliver care to the Cree and Ojibway people and to provide consultation and training to the service delivery providers in the area. The program is part of a larger medical program operated by the university and financed by the Canadian government. Psychiatrists face numerous cultural and language obstacles in addition to harsh weather conditions and limited means of communication in the vast Sioux Lookout zone. When they are back in Toronto, they keep in touch via two-way radio with professional staff in the zone for ongoing consultations.
Awards and Prizes↗
The University of Toronto liver transplant program.
The University of Toronto liver transplant program began in 1985 at a time when the procedure had already evolved from an experimental form of surgery to an accepted treatment for many forms of liver failure. The program was established not only to provide clinical care for patients but also to address academically the barriers which impeded success. The program brought together experts in medicine, surgery, pathology, and the basic sciences of immunology, virology and molecular biology. Our group has had a special interest in transplantation for viral hepatitis. We demonstrated the role of HBV DNA as a prospective factor in both viral recurrence and survival. We further studied a number of agents to prevent re-infection including PGE, HBIG and more recently lamivudine. Although the short-term results of transplantation for HCV appear excellent, reinfection of the graft and development of chronic hepatitis and cirrhosis may make long-term results problematic. Therefore, we have directed attention to studies of pathogenesis and treatment of HCV in liver transplantation. Our studies have demonstrated a unique role for ribavirin as an immunomodulatory agent which can benefit the course of posttransplant HCV. Future studies will examine combination therapy in an attempt to eradicate the virus. Our group also has been interested in PNF and FHF and have demonstrated a positive effect of PGE in this setting. As we look to the future, the greatest challenges facing transplantation are the shortage of organ donors and the toxic effects of long-term immunosuppression. Our group now has established research efforts both in tolerance induction and xenotransplantation which we feel are necessary to make transplantation an effective, universal treatment for end stage organ failure.
Adult↗
"German methods," "unconditional gifts," and the full-time system: The case study of the University of Toronto, 1919-23.
At the end of 1919, The University of Toronto got word that the Rockefeller Foundation was looking to give the university a gift of one million dollars (US) to "aid medical education.". This was in addition to a gift of $500,000 (Canadian) from merchant millionaires Sir John Craig and Lady Eaton. The implementation of the full-time system of clinical instruction made possible by these large gifts touched off a fiery debate among the medical profession and prompted a provincial government inquiry that would have thwarted long-awaited innovations in medical teaching and threatened the autonomy of the entire university. Much has been written about the full-time system of clinical medical education, most of it dealing with the United States. Some have documented cases where donor dollars were scorned in aiding the shift to full-time clinical teaching. Less well known is the tale of the University of Toronto. "The Provincial University" is an unique case study of a public university that tried to satisfy donor conditions even as it served its constituency- the people of Ontario. The challenge of implementing a new medical pedagogy between 1919 and 1923 was that Toronto lay at the centre of three poles: private versus public funding; "research" or laboratory medicine versus "experience" or "practical" medicine; and those who wanted to try the full-time system versus the established "old guard."
Canada↗
The development of medical education on alcohol- and drug-related problems at the University of Toronto.
Medical education on alcohol- and drug-related problems at the University of Toronto covers undergraduate, residency and graduate programs, a result of collaboration since 1959 between the university and the Addiction Research Foundation of Ontario. An undergraduate core curriculum, developed in the early 1970s, is offered in year 2; it has been supplemented by electives, selectives and comprehensive clinics. The undergraduate program is rated highly by students; since 1978, 3024 have completed the core program. Residency training started in 1974 and is available through electives lasting from 1 to 12 months in internal medicine, psychiatry, and family and community medicine. To date, 370 residents have completed one of these electives; 129 have completed graduate programs in which their theses concerned alcohol- and drug-related topics, and there have been an additional 13 research and postdoctoral fellows. Despite the progress, there is still a need to improve and expand the undergraduate and residency programs and to develop an effective program of continuing medical education. The goals should be to ensure that, as far as possible, all medical graduates from the University of Toronto have the knowledge, attitudes, skills and behaviours needed to contribute effectively to the prevention and treatment of alcohol- and drug-related problems in their chosen field of practice and to avoid problems from their personal use of alcohol and other drugs.
Academic Medical Centers↗
Research initiatives at the University of Toronto Environmental Hypersensitivity Research Unit.
The Environmental Hypersensitivity Research Unit at the University of Toronto is following a research strategy to develop and evaluate diagnostic methods for environmental hypersensitivity. These methods will be used to identify cases for inclusion in studies of disease etiology and therapy. The Research Unit has actively sought consultation and collaboration with researchers at the University of Toronto, clinicians from a variety of specialties, and patients. It is hoped that such a multidisciplinary approach will lead to the generation and testing of innovative hypothesis with rigorous methodology and, ultimately, to increased understanding of the complex conditions known as environmental hypersensitivity.
Canada↗
Contributions of observational cohort studies in systemic lupus erythematosus: the university of toronto lupus clinic experience.
This article uses the University of Toronto Lupus Cohort to illustrate the benefits of observational cohort studies in generating important new knowledge in chronic disease such as systemic lupus erythematosus.
Cohort Studies↗
The University of Toronto Liver Transplant Program: Toronto General Hospital, Hospital for Sick Children.
The University of Toronto Liver Transplant Program began in 1985 at a time when the procedure had already evolved from an experimental form of surgery to an accepted treatment for many forms of liver failure. The program was established not only to provide clinical care for patients but also to address academically the barriers that impeded success. The program brought together experts in medicine, surgery, pathology, and the basic sciences of immunology, virology and molecular biology. Significant advances over the past decade and a half in immunosuppressive drugs and monitoring, patient selection, and infectious management have contributed to markedly improved patient and graft survival rates. Nevertheless, we continue to face 2 major challenges: a growing scarcity of donor organs, a problem partially addressed through development of living-related liver donation, and recurrent viral hepatitis. We expect to remain on the forefront of ongoing research to provide solutions to these and other barriers to the full deployment of liver transplantation in the year 2000.
Adult↗
The hiring of James Mark Baldwin and James Gibson Hume at the University of Toronto in 1889.
In 1889, George Paxton Young, the University of Toronto's philosophy professor, passed away suddenly while in the midst of a public debate over the merits of hiring Canadians in preference to American and British applicants for faculty positions. As a result, the process of replacing Young turned into a continuation of that argument, becoming quite vociferous and involving the popular press and the Ontario government This article examines the intellectual, political, and personal dynamics at work in the battle over Young's replacement and its eventual resolution. The outcome would have an impact on both the Canadian intellectual scene and the development of experimental psychology in North America.
Canada↗
Implant prosthodontics in medically challenged patients: the University of Toronto experience.
A series of prospective studies started in the mid-1980s at the University of Toronto have provided evidence of the efficacy and effectiveness of implants in the treatment of the fully and partially edentulous patients. These studies have focused primarily on treatment outcomes at the surgical and prosthodontic levels, with an overall failure rate of 7.7% over a 20-year period. Because a considerable proportion of these failures (4.2%) occurred before insertion of the prosthesis, and because osseointegration is essentially a wound-healing process, factors that interfere with healing, including systemic conditions, may contribute to implant failure. This paper reviews studies on the impact of selected systemic conditions, including osteoporosis, cardiovascular diseases, diabetes mellitus, and hypothyroidism, as well as smoking behaviour, on the success or survival of oral implants in patients treated in the Implant Prosthodontic Unit at the University of Toronto.
Cardiovascular Diseases↗
The University of Toronto "Sioux Lookout Project"--a model of health care delivery.
The University of Toronto's Sioux Lookout Project is described in detail. The scheme is a collaborative one in which universities, governments, doctors, dentists, nurses, communities and consumers participate. After three years of operation it appears to be a feasible model for delivery of health care in a remote area under extremely adverse conditions. It is suggested that a modified version would be applicable to other underdoctored areas. The individual roles of the various participants are outlined. Universities, by giving some preference in their postgraduate training programs to doctors who have spent a year in practice, especially in remote areas, would make a major step towards correcting the maldistribution of doctors.
Comprehensive Health Care↗
Hospital policy on appropriate use of life-sustaining treatment. University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force.
OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment.
Hospital Administration↗
Blending vigorous leadership and womanly virtues: Edith Kathleen Russell at the University of Toronto, 1920-52.
This article attempts to explore the gendered attributes of leadership. Using archival resources and interviews with former nursing faculty this article examines the leadership qualities of one woman, Edith Kathleen Russell, in one campaign, the struggle for a nursing program at the University of Toronto. The nursing program was established at the University of Toronto in 1920, a time when women's public contribution remained firmly tied to their traditional feminine qualilties. Kathleen Russell was faced with the virtually impossible task of balancing the traditional feminine qualities while practising the aggressive qualities associated with leadership and authority. Russell was successful in promoting university nursing education when she worked within the confines of gender-determined behavior. When her strong will, determination, and persistence became evident, she was silenced. The dilemma of how to blend traditional feminine characteristics with assertive leadership remains.
Canada↗