Patient “Gregory” is a 31-year-old male seen in the UW Dental Urgent Care Clinic for tooth pain in a tooth that has obvious decay. We were unable to provide dental treatment to “Gregory” today due to his elevated blood pressure. He was prescribed Amoxicillin for an abscess and asked to return once his hypertension is controlled.  Please evaluate Gregory for hypertension. We will provide the necessary dental treatment after his blood pressure has been reduced.

Teams of health sciences students huddled to plan the course of care for Gregory.

The exercise, titled Providing Care across Settings, was the second in the new Foundations of Interprofessional Practice curriculum, a seven-session, year-long series. Students from across the health professions schools work together in the same teams solving real health challenges. The curriculum is part of the Interprofessional Education Initiative: Vision for a Collaborative Future, launched last year by the UW Board of Health Sciences Deans. The initiative promotes progressive integration of collaborative learning across the UW’s six health sciences schools —dentistry, medicine, nursing, pharmacy, public health and social work. (Read about the first session in .)

In the second session, held Oct. 10, nearly 600 health sciences students and some 50 faculty members participated in the “Gregory” exercise, in locations across the UW campus.  The exercise helped students communicate and practice as a team in guiding the patient to appropriate healthcare professionals. The goal: provide safe, timely, efficient, effective and equitable care.

Jennifer Danielson, assistant professor of pharmacy, led the interdisciplinary team developing the case. Other case development team members included Kimberly Huggins, affiliate instructor of oral medicine in the School of Dentistry; Megan Moore, assistant professor of social work; Elizabeth Kaplan, attending physician in medicine; Karen McDonough, associate professor of medicine; and Brenda Zierler, professor of biobehavioral nursing and health systems in the  School of Nursing.

“This was the first time we’ve developed such a case with both the dental and social work faculty–a groundbreaking project for health sciences at UW,” Danielson said. “We purposefully highlighted the expertise of dentists, social workers, pharmacists, nurses, and dietitians in this exercise so that everyone could ‘see themselves’.
Together, student groups representing diverse health disciplines discussed Gregory’s medical, socioeconomic and psychosocial history.

Gregory is unemployed and doesn’t know the date of his last physical exam. He rates his health as fair and his oral health as poor. He eats lots of fast foods. His family has no history of hypertension. He does have a history of drug use (meth, but has been clean for the past two years.) He has smoked 5 to 10 cigarettes per day for a decade.

One group  of students determined that Gregory needed many services and designated the most appropriate healthcare professionals to handle care:

• Thorough physical exam (physician, physician assistant, nurse)
• Hypertension control (physician, physician assistant, pharmacist)
• A primary care medical home, with dental care included (physician, dentist, physician assistant, pharmacist, nurse, social worker)
• Full dental work-up with X-rays (dentist)
• Smoking cessation (dentist, physician , physician assistant, nurse, pharmacist, social worker, hotline)
• Toxicology screening to stay sober (physician, physician assistant)
• Stability evaluation  for housing, employment, insurance, drug use (social worker)
• A more thorough social history (dentist, physician, physician assistant, pharmacist, nurse, registered dietician, social worker)
• Patient education (all health care professionals)
• Dietary counseling (registered dietician)

In the scenario, Gregory missed his follow-up appointment and did not pick up his medications. The teams tried to understand why this occurred.

The groups also discussed possible barriers to Gregory’s healthcare: unemployment, drug use, and lack of money, transportation, and understanding of his disease.

Danielson queried the class, “In dealing with barriers,  Who else can help?”

Students piped up: “A social worker could help the patient explore affordable health care coverage resources and transportation options.”

“Gregory needs education about the medication, side-effects and how to minimize the side effects. We need to talk to him about his long-term quality of life.”

A dental student summarized her team’s conclusion:

“If the hypertension is resolved or controlled, the patient would return to the dentist for follow-up and be treated as a normal patient.  Otherwise, the dentist would need a medical consult if the hypertension remains high.”

Gregory’s case was officially closed, but the interprofessional teamwork had formally begun.

The deans of the UW’s six schools of health sciences – dentistry, medicine, nursing, pharmacy, public health and social work — started the Interprofessional Education Initiative: Vision for a Collaborative Future that aims to foster collaborative learning across the schools.

“This is the single-most important multidisciplinary initiative of our time, in terms of impact and scope,” said Pharmacy Dean Thomas Baillie, head of the UW Board of Health Sciences Deans, which made the decision.

The nature of health care is changing rapidly and significantly; much of it driven by cost and technology, and a changing workforce,” Baillie said.

“Our structure of having all six schools in close proximity helps collaboration,” he said. “This is an opportunity to impact health care in Washington to make it more effective, higher quality and lower cost. Ultimately, this approach will lead to more effective and economical delivery of health care and education, as well. ”

The 600 students from all six health sciences schools are participating in the new Foundations of Interprofessional Practice curriculum, a seven-session series in which students work together in teams solving real health challenges.

“What really excites me is seeing students think outside the box and understanding that they can make many contributions to the treatment of patients beyond what they face in their individual disciplines by participating jointly in solving problems,” Baillie said.

A workshop to help faculty prepare for interprofessional education was led by Karen McDonough, associate professor of medicine, and Brenda Zierler, a professor of behavioral nursing and health systems and the principal investigator on the grant from the U.S. Health Resources and Services Administration that helps to fund the initiative. Additional funding came from the Josiah Macy Jr. Foundation.

“This year we’re laying the foundation of interprofessional practice by having students participate in seven sessions over the year,” McDonough said. “The sessions will include collaborative learning projects, role-playing, individual and group learning plans and case studies that approximate situations, such as medical error disclosure, that may be faced on the job.”

After an initial meeting, students from medicine, nursing, dentistry, pharmacy, social work and physician assistant programs shared thoughts about their experiences and insights.

A social work doctoral student knew that team-based solutions are more beneficial. “I knew this intuitively, but to experience it in a short time and with such diversity around the table brought new insight.”

A second-year medical student said, “Talking with students in different degree programs was the first time I learned about training involved in these other programs, which definitely gave me a better understanding of the role they play in patient care.”

Matthew Smith, a first-year physician assistant student, said the greatest insight for him “was hearing that this is not just a theory, but that there is evidence that demonstrates better patient care when teams collaborate.” That means, for example, shorter hospital stays and fewer medical errors.

“This is an opportunity to impact health care in Washington to make it more effective, higher quality and lower cost,” Baillie said. “Ultimately, this approach will lead to more effective and economical delivery of health care and education, as well.”

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Brian Wansink, the John S. Dyson Professor of Marketing at Cornell University, has spent much of his life thinking about food and wondering about Americans’ relationship to it.

“I grew up in Sioux City, Iowa. Like a lot of people in the Midwest, I spent a lot of my early years around food. I spent my summers walking the bean fields, selling vegetables, and later delivering pizza,” Wansink said in a phone interview. “I always found it puzzling that so much of the world has a very different view towards food than we Americans do. In most of our environment, food is incredibly affordable, incredibly attractive—incredibly available.”

A keen observer of human behavior, Wansink’s early curiosity led him to study behavior that affects food choices.

Wansink will give the 21^st John R. Hogness Symposium on HealthCare, entitled Slim by Design: Scientific Approaches to Eating, from 3 to 4:30 p.m., in Hogness Auditorium, Health Sciences Center, Monday, Oct. 14.  Wansink is director of the Cornell Food and Brand Lab and co-director of the Cornell Center for Behavioral Economics in Child Nutrition Programs, and a pioneer of the Small Plate Movement. He holds a doctoral degree in consumer behavior from Stanford University, founded the Food and Brand Lab at the University of Illinois, Urbana-Champaign, in 1997 and moved the lab to the Department of Applied Economics at Cornell University in Ithaca, N.Y.,  in 2005. From 2007 to 2009, he was executive director of U.S. Department of Agriculture’s Center for Nutrition Policy and Promotion, the federal agency that developed the 2010 Dietary Guidelines and promoted the Food Guide Pyramid.

Best known for his work on consumer behavior and food, and for popularizing such terms as “mindless eating,” Wansink studies how microenvironments influence what and how much people eat and how much they enjoy it.

“We study the ways the cues in our environment lead us to eat too much and too much of the wrong food. There are powerful, very small changes that can help us to mindlessly eat less than mindlessly overeat.”

Wansink thinks the solution to changing eating behaviors is not through traditional education, but by changing our food environments.

“We all know that eating an apple is better for you than eating a cookie. But, what do most of us want 70 percent of the time? It is certainly not the apple.  What can we do to nudge ourselves to eat better?

“There are five places in our food environment where we virtually purchase and eat all of our food. Those places are our homes, workplaces, schools, grocery stores and restaurants.  If each of us made a couple of personal changes in those areas and encouraged those places to make one or two changes to help us, our lives and those of most of our neighbors would be better.”

To illustrate how small environmental changes can make a difference in food consumption, Wansink cited some research findings from his lab.

“For example, portion size. The better determinant of how much we are going to eat today than yesterday, is what size of a plate we’re going to serve our dinner on. If we serve off of a 10-inch plate rather than a 12-inch plate, we will serve ourselves 22 percent less food,” Wansink said. “Our research finds that if a person eats off of a 10-inch plate instead of a 12-inch and is then asked if they’re still hungry, they will say, ‘No, I ate a full plate of food.’

“The biggest determinant of whether you are going to go for seconds is whether the serving bowl is on the table or six or more feet away from you. The average person eats 19 percent less food when the food is six or more feet away. “

Wansink said changing the way Americans eat will take a collective effort of individuals, the food industry and governments working together to change the environments in which Americans purchase and consume their food.

Wanskink is the best-selling author of Mindless Eating: Why We Eat More Than We Think (Bantam Dell, 2006). He writes Chew on This, a column on food behavior, for MSNBC, and Food Think with Wansink, a column on nutrition for Prevention.com. His latest book, Slim by Design: Mindless Eating Solutions for Everyday Life, will be published by William Morrow in March 2014.

Evidence is accumulating that not only is it possible to slow down aging, but that by doing so the onset and progression of multiple age-related diseases can be delayed, according to a review by ����Ӱ�Ӵ�ý scientists in the journal Nature.

“Slowing aging should increase both lifespan and healthspan — the period of life spent in relatively good health, free from chronic disease or disability,” the authors write.

“A shared feature of most medically relevant diseases is that your risk of dying from them increases dramatically as you get older,” said Matt Kaeberlein, senior author of the paper. “Unlike traditional approaches, which tend to focus on a specific disease, targeting the aging process itself has a much greater potential to improve human health.”

UW scientists examine how the inhibition of the protein mTOR, which stands for “mechanistic target of rapamycin,” may modulate aging and age-related disease. The review was written by Simon Johnson, a graduate student in pathology; Peter Rabinovitch, professor of pathology; and Kaeberlein, associate professor of pathology.

Many experts in the biology of aging believe that pharmacological interventions to slow aging are a matter of ‘when’ rather than ‘if’. A leading target for such interventions is the nutrient response pathway defined by mTOR, a protein that controls cell growth.

“Inhibition of this pathway extends lifespan in model organisms and confers protection against a growing list of age-related pathologies. Characterized inhibitors of this pathway are already clinically approved, and others are under development. Although adverse side effects currently preclude use in otherwise healthy individuals, drugs that target the mTOR pathway could one day become widely used to slow aging and reduce age-related pathologies in humans,” said the authors.

The authors compare the effects of mTOR inhibition to the positive effects in rodents of dietary restriction in extending the lifespan and delaying the incidence of age-related decline and disease, including cancer, cognitive decline and neurodegeneration.

“Emerging evidence suggests that, like dietary restriction, mTORC1 inhibition may have similar positive effects on multiple age-related pathologies in rodents and, in some cases, humans,” according to the scientists.

Learn about the work under way in the

The UW has National Institutes of Health-funded Centers of Excellence in the basic biology of aging (Nathan Shock Center), Alzheimer’s disease (Alzheimer’s Disease Research Center), and Parkinson’s Disease (Morris K. Udall Center), and is working with Kaeberlein to establish the UW Healthy Aging and Longevity (HALO) Research Institute.

“It may sound a bit like science fiction,” said Kaeberlein, “but there is growing confidence in the field that we really can develop drugs that slow human aging and extend the period of healthy life for most people. Imagine what you could do with an extra 10 or 20 years of youthfulness.”

Read more in .

The UW community is invited to celebrate the completion of the 273,000-square-foot Montlake Tower expansion at UW Medical Center on Friday, Oct. 5, and Saturday, Oct. 6. Staff and faculty can tour the new facility from 7-9 a.m., 11:30 a.m. to 1:30 p.m. and 5-7 p.m. on Friday, Oct. 5.  An open house and tour for the broader community is scheduled from 10 a.m. to noon on Saturday, Oct. 6.

The Montlake Tower, on the south side of UW Medical Center, incorporates state-of-the-art architectural, technological and environmental design elements to enhance patient and staff experience. The $210 million project offers spacious patient rooms and work areas, scenic views, natural and custom lighting, and energy efficiency.

Construction of the new eight-story building was begun in April 2009. This phase of the project includes increased capacity for oncology and neonatal intensive care unit patients, as well as more space for leading-edge digital imaging technology. Two floors will house administration and three floors are shelled for future expansion.

Here are some of the features of the new building:

Oncology Services expansion on the eighth floor includes 30 single rooms for patients with blood diseases; two isolation rooms for greater infection control; and a comfortable family lounge with household amenities, including bath and shower, comfortable sitting spaces, washer/dryer and kitchenette. Staff conference room has interactive white boards and videoconferencing capability to promote medical education among staff and distance learners.

Neonatal Intensive Care Unit expansion on the fourth floor can accommodate 47 infants in 39 single rooms and four rooms for twins, making it one of the largest neonatal ICUs in the Pacific Northwest. The new neonatal ICU includes an infant operating room, a pediatric pharmacy, a family lounge with household amenities, and an advanced security system. The floor also provides “front porch” benches along the corridor to foster conversation and community among family members. Centrally located rounds area offers a shared work space for multidisciplinary team.

Radiology expansion on the second floor includes leading-edge digital imaging technology for diagnosing and treating brain tumors and neurovascular and vascular diseases. The new space includes four CT scanners, two magnetic resonance scanners and four angiography suites. The interventional radiology suite is custom-designed by Philips so that, if necessary, patients can have all three types of treatment in one session.

The Montlake Tower was designed by NBBJ architects and designers. Skanska was the general contractor and construction manager.

On Twitter @UWMedicineNews:  Follow #MontlakeTower now and all through next week for sneak peeks and facts about UWMC’s brand new medical facility