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A Europe-wide process to evaluate and validate biomarkers buy generic procyclidine on line symptoms juvenile rheumatoid arthritis, together with longitudinal and Challenge 5 Shaping Sustainable in-depth studies to further characterise diseases and their Healthcare progression would support on-going eforts towards this integration and re-classifcation (18 generic 5 mg procyclidine overnight delivery medications that raise blood sugar,19) purchase procyclidine master card symptoms xanax treats. Patients and the citizen will play an increasingly important role in adopting and controlling the use of data from electronic health records and in developing Challenge 4 Bringing Innovation prospective surveillance and monitoring systems for per- to the Market sonal health data (30,32). Specifying the chal- of molecularly defned tumour subgroups to specifc inhi- lenges and obstacles that will be faced by researchers, bitors. In comparison to chemotherapy a substantially im- industry, policy makers and healthcare providers will faci- proved outcome is described in an increasing number of litate the development of strategies and the identifcation cancer entities with this approach. In addition, key Europe- nal high-level stakeholders participants were introduced an organisations and institutions have published reports, to the topic and made familiar with the results of the ana- guidelines and roadmaps. From this analysis an inventory of the sessions were presented and discussed with the of recommendations was prepared and grouped into key entire audience to ensure that cross-sectoral issues were areas. These stakeholders were invited to the PerMed work- shops and/or participated in semi-structured interviews. Interviews were conducted either fa- PerMed webpage) ce-to-face or over the phone. In total 35 experts from the following four areas were interviewed: (1) basic research Dialogue platform exclusively for funding organisa- and new technologies, (2) translational research, (3) regu- tions Round Table PerMed : As part of the dialogue lation and reimbursement, and (4) healthcare systems in platform the PerMed Round Table PerMed was set up. All fnal interview summaries were approved by Round Table is a forum for ministries and funding organi- the respective experts. Key issues include: the establishment of a strong Personalised Medicine refers to a medical model culture of collaboration between all relevant research using characterisation of individuals phenotypes and areas in a true public private partnership, the adaptation genotypes (e. On the other hand, diseases that display rather dife- using omics and related technologies (e. The approach has through the internet and the consequent rise in health li- the potential to ofer medium- and long-term gains to teracy of patients and citizens. These trends are likely to patients and to society and should signifcantly outweigh change the way that healthcare clients and providers in- the required initial investment. This can being defned as the entire range of research along the only be achieved when standard protocols with regard to healthcare value chain. This includes not only basic and diagnostic tests and treatment are used in treatment cent- translational research, but also research relating to regu- res; these centres can then serve as partners jointly execu- latory aspects, new fexible health technology assessment ting a particular trial. Furthermore, there are manifold interrelations between the fve challenges; these have not been indicated in order to keep the clearness of the fgure. This is not meant to imply that the particular recommendation may not be equal- Recommendations on biomedical, health-related ly relevant to other challenge areas. All recommendations ces research have been colour-coded according to the activities re- ferred to, which are grouped into three broad areas. In these cases, the recommendation has 11 4) Challenges for the further implementation of Personalised Medicine Challenge 1 Developing Aware- tive Pathways to Patients) represents a frst and welcome ness and Empowerment step in this direction. Instead of lenges in the areas of patient information, data protection merely treating a disease, a shift to a more holistic appro- and data ownership. In order to do this, it will be patients feel more left alone, becoming responsible them- fundamental to establish shared practices and a com- selves for managing complex treatment regimens, which munication network. Furthermore, a move towards more preventive approaches to healthcare Empowerment Providers in the health sector, citizens, is expected and needed. Networks of stake- challenges, and are capable and willing to support its im- holders, researchers, clinicians and patients/citizens who plementation. In addition, the stu- dy of genomics can provide information about an individu- 1. Provide further evidence for the beneft deli- al s reaction to a particular pharmaceutical product. Once clinical and personal utility cons of this option will support decision-makers in this as well as economic sustainability are proven in a precisely sensitive feld. These developments should be supported defned indication, a strategy for the communication and in the light of a holistic approach carefully avoiding the dissemination of the possibilities, challenges and potenti- risk that the citizen might only be seen as a sum of data. One example could be feasibility studies on health data cooperatives with an assessment of ethical, legal and soci- 2. Develop and promote models for individual al implications comparing diferent European healthcare responsibility, ownership and sharing of per- system settings. An appropriate data ownership framework for ment pathways and track the safety and efec- patients will therefore be needed, especially given that tiveness of these interventions. The implementation of this recommen- ethical basis for integrating data generated about and by dation 2 and 3 will strengthen the fnality for the patients users into health information collected by medical profes- beneft. Additionally, a framework for the management and communication of predictive information derived 4. For this rea- data silos of national healthcare systems and so improve son fexible and adaptable guidelines will be needed to interoperability. Personal and economic benefts evolve and incorporate lessons from experiences of the 13 various stakeholders; so for example the efect in terms tient advocacy organisations; 3) supporting lifelong lear- of justice and fairness in healthcare is difcult to predict ning and skills to promote good health. Improve communication and education stra- althcare system and increase the patient s role tegies to increase patient health literacy. Develop common principles and legal frame- lic and private sector organisations deliver information works that enable sharing of patient-level in ways that make it difcult to understand and act on, data for research in a way that is ethical and or that are even incomplete and inaccurate. This stratifcation will the skill and competence of health professionals, patient greatly reduce the number of patients within any such advocacy organisations, media and government and subgroups. In view of this, international co-operation will private sector agencies to provide health information in become increasingly important in order to recruit suf- a manner appropriate to their audiences are as equally cient numbers of patients for the generation of statisti- important as an individual s skills. Europe involve a strong voice from patient advocacy groups to adequately balance the interests of the individual patients In May 2011 the Health Directorate of the European and society as a whole. Commission s Directorate General for Research and In- novation organised the conference European Perspec- tives in Personalised Medicine, which aimed to take Key Enablers for Challenge 1 stock of recent achievements in health-related research Europe: e. Ministries of health, fnance, re- ritise future actions needed at the European level. Recently members king Groups develop positions on key topics and of these societies have published an opinion paper make proposals and recommendations to the Forum. Patient recruit- In Canada, the Canadian Institutes for Health Research ment consents and ethics; 4. Increasing the impact of research jects in various diseases areas were funded through and development investment. Develop- comprehensive cataloguing of high quality biobank speci- ment of prospective surveillance and monitoring systems mens and biomarkers, and their use in all large-scale studies for personal health data will also contribute to the accu- on patient and population cohorts ( top-down approach ) mulation of data on individuals across their life course. Thus it is not only omics or imaging technologies misinformation on diseases, their symptoms and potential that will generate vast amounts of data. Aspects include: (1) how health records data from diferent types of registries and to store and provide access to huge amounts of human emerging fows of unstructured data coming from, for ex- health-related sensitive data under a secure and common ample, connected objects or social media. Even though of huge datasets taking into account the fact that storage the launch of translational projects as a main driver for pro- may be either centralised or decentralised; (3) how to in- ducts and services development is key, market successes terrogate such data; and (4) how to link such data to ex- 18 perimental data.

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Early evidence suggests that patients who are assessed in clinics like these purchase cheap procyclidine medicine 8 iron stylings, have a higher rate of survival buy procyclidine 5mg without prescription symptoms detached retina, although this may also be affected by other aspects of care buy procyclidine 5mg fast delivery medications zopiclone. The obvious benefit of preoperative assessment is the opportunity to optimise treatment of existing disease, and plan for care during and after surgery. However, these assessments also inform the discussions between doctor and patient, on whether surgery is the best option if the risks outweigh the benefits. Preoperative assessment provides an opportunity to optimise treatment of existing disease, and make a detailed plan for care during and after surgery. The profession of anaesthesia presence of a highly-trained anaesthetist, supported has led a programme of innovation and safety, and within a multi-disciplinary team, provides an easy permanent harm caused by technical errors during opportunity for the delivery of treatments which are surgery is now considered to be rare. Whilst the need complex or need significant medical input, without to maintain the highest safety standards will never disrupting the surgical care pathway. It is increasingly cease, the greatest challenge of care during surgery necessary to see the care provided during surgery, not has now become the need to improve the quality as an isolated episode, but as part of a continuum of patient care. Severe pain delays patient recovery, and prevents adequate breathing leaving patients more at risk of pneumonia and myocardial infarction, and in some cases it develops into chronic pain which can cause life-long disability. As many as one in ten patients having a knee replacement experience long-term pain afterwards. As perioperative physicians, anaesthetists are ideally placed to prevent and treat pain following surgery. The anaesthetist takes primary responsibility for assessing the risk of acute and chronic pain and for developing a robust plan for pain management. This approach to effective pain management helps to reduce the risk of complications such as pneumonia, and speeds patient recovery. The prevention and treatment of pain is an excellent example of perioperative medicine. Whilst not a fundamental part of treating the index disease (such as cancer or arthritis), we all recognise that it is essential to treat this consequence of surgery in order to give the patient the best chance of a safe and speedy recovery. Acute pain teams also offer a model of care for the multi-disciplinary perioperative medicine team early after surgery. Whilst not leading the care of every patient, they provide expert advice and guidance as well as seamless continuity of care from surgery to patient discharge. Patients at risk of severe pain are reviewed on the surgical ward by a multi- disciplinary acute pain team. There is growing recognition that safety and quality of care are at two ends of a single continuum that ensures the best possible outcomes for patients. During implementation, local variation of the layout and content of the checklist allowed hospitals to tackle their individual needs, promoting a sense of ownership, and improving adoption. The three core components of the checklist are: the sign in before anaesthesia, time out before surgery begins and sign out before any member of the surgical team leaves the operating theatre. Recent research across Europe has shown significant international variation in use of the surgical checklist, and vitally that exposure to a checklist is associated with reduced mortality after surgery. We don t know whether the checklist itself prevents frequent harm, or that it is used more commonly where the quality of care is higher. However, it is clear that the need to improve the quality of perioperative care is as important as maintaining high standards of safety. Maintaining high standards of care for patients with long-term disease, becomes a major challenge as they undergo surgery. Patient All hospitals deliver a package of perioperative care excellent understanding of how complications develop that is focussed on the needs of the individual patient, after surgery, but are rarely given the time to review as determined by the specific surgical procedure. The review will last management of acute and chronic medical disease, until the autumn of 2015 and will be considering a but may have less insight into how major surgery number of areas, including the role of enhanced care may modify such conditions. Caring for long-term disease after surgery Twenty years ago, it was very common to find that patients were not offered surgical treatments because of increased risk due to co-morbid disease. As perioperative care has improved, we find that these patients are now offered surgery as a matter of routine, with the same expectations of success as the wider surgical population. Maintaining high standards of care for patients with long-term diseases, becomes a major challenge as they undergo surgery. This disease is associated with increased rates of cancellation before surgery, complications such as wound infections, and prolonged hospital stay after surgery. Patients are now routinely admitted on the day of surgery, even for major procedures, creating particular challenges for diabetic patients. All diabetic patients are offered an additional screening test called HbA1c as part of their routine preoperative assessment. Those with high values are seen by the diabetic team within ten days, to review their diabetic medication in the context of surgery, as well as to offer other routine care that diabetic patients need. This service provides important support, but requires on average only one day each week from the diabetic nurse specialist to accommodate referrals. The service promotes communication between diabetes experts, surgeons and anaesthetists to ensure high quality care within an efficient surgical service. Importantly, colleagues in primary care have also commented on the utility of this approach which provides a valuable model of care for the short-term management of surgical patients with long-term disease. The introduction of perioperative medicine teams would help us to ensure that all long-term diseases are managed in this way during the perioperative period. For many years, we have admitted these patients to a Critical Care Unit for 24 48 hours after surgery. When critical care beds are not available, clinicians must decide between cancelling surgery, or proceeding with less care than they believe the patient needs. However, surgical patients don t need all the facilities that a modern intensive care unit offers. In fact, a much simpler facility would be more efficient and still offer the care patients require. However, in most hospitals this is part of a nurse-led, protocol-driven form of care known as fast-track cardiac surgery. One hospital in London has for many years admitted all high-risk patients to an Overnight Intensive Recovery unit which functions much like a normal post-anaesthetic care unit. Patients are admitted for up to 24 hours before they are discharged to the ward or to a fully-equipped intensive care unit, depending on need. This provides a facility for the provision of cardiac or respiratory organ support (much like a critical care unit), as well as a focus on pain management and other common postoperative problems (much like a post-anaesthetic care unit). Patient flow is not a problem because places in the unit are not considered to be hospital beds. This ensures all patients receive the level of care they need whilst avoiding the need to cancel procedures when critical care beds are not available. Our reliance on care in hospital is consider the impact of major surgery in the context unsustainable, inefficient and frequently fails to of patients long-term health. As we work need support and excellent communication from a to ensure patients recover quickly after surgery, the team of experts who understand the impact major number of days they spend in hospital will steadily surgery has on their individual patients, advising decrease. As we offer surgery of their patient s progress in the weeks and months to more older patients, and to those with long-term following surgery. As we offer major surgery to more and more patients with risk factors for kidney disease, more patients experience damage to their kidneys as a result of the systemic inflammatory response to surgery.

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Extramedullary haemopoesis causes hepato- Other treatments under investigation include gene splenomegaly purchase discount procyclidine online medicine river animal hospital, maxillary overgrowth and trabecula- therapy and drugs to maintain the production of fetal tion on bone X-rays buy discount procyclidine 5 mg line symptoms 0f pneumonia. Random X inacti- vation (Lyonisation) means that some heterozygous fe- Glucose-6-phosphate dehydrogenase males may also have symptoms generic procyclidine 5 mg with amex symptoms 7 weeks pregnancy. Clinical features With such a wide variety of genes and enzymatic activity, Aetiology aspectrum of clinical conditions occur. Investigations Pathophysiology During an attack the blood lm may show irregularly IgMorIgG antibodies are produced, which bind to red contracted cells, bite cells (indented membrane), blister cells. Autoimmune haemolytic anaemia Denition Clinical features Acquired disorders resulting in haemolysis due to red The clinical features, specic investigations and manage- cell autoantibodies. Splenectomy may be indicated if lymphatic leukaemia, haemolysis is severe and carcinoma and drugs such refractory. Cold haemagglutinin May be primary or secondary IgM antibodies agglutinate best Treat any underlying cause and disease to Mycoplasma at 4C, often against minor avoid extremes of temperature. Denition A pancytopenia due to a loss of haematopoetic precur- Investigations sors from the bone marrow. Full blood count and blood lm will demonstrate a pan- cytopenia with absence of reticulocytes. A bone marrow Aetiology/pathophysiology aspirate and trephine shows a hypocellular marrow with Aplastic anaemia can be either congenital or much more no increased reticulin (brosis). This agents, supportive care (blood and platelet transfusions) is an autosomal recessive aplastic anaemia with limb and some form of denitive therapy. Otherdrugsmaycauseaplasticanaemia Immunosuppressive therapy is used as rst line treat- through dose dependent (e. Prognosis Clinical features The course is dependent on the severity of the dis- Patients present with the features of pancytopenia: ease and the age of the patient. In the United Kingdom, travellers to these ar- 3year survival but there is a signicant risk of developing eas who do not take adequate precautions are at greatest paroxysmal nocturnal haemoglobinuria, myelodysplas- risk. Transmission occurs predominantly by the bite of the female Anophe- Denition les mosquito although transmission may occur by blood Malaria is an infection caused by one of the four species transfusion or transplacentally. Incidence Worldwide there are 300 500 million cases of malaria Pathophysiology peryear with a mortality rate of up to 1%. In the United Parasites consume red cell proteins, glucose and Kingdom there are 1500 2000 cases per year, most of haemoglobin. They affect the red cell membrane making which are caused by Plasmodium falciparum. The inci- the cell less deformable and ultimately causing cell ly- dence in the United Kingdom is rising. Falciparum induces cell surface adhesion molecules on red cells causing adhesion to small vessels and un- Geography infected red cells. This leads to occlusion within the Endemic malaria is found in parts of Asia, Africa, Cen- microcirculation and organ dysfunction. Resistance to tral and South America, Oceania and certain Caribbean malaria is conferred by genetic variation: 1. Fertilisation occurs forming sporozites Sporozoites which migrate to the salivary glands. Sporozoites develop within hepatocytes over weeks before being released as merozoites. In vivax and ovale some remain in liver as a latent infection Release as merozoites Erythrocytic phase 3. Merozoites enter red blood cells, and pass through several stages of development finally resulting in multiple 4. The red blood cells rupture phase a few merozoites releasing merozoites into the circulation. In the able to swallow, is vomiting or has impaired con- gametocyte stage there is genetic recombination causing sciousness intravenous quinine is used. Treatment should be considered in patients with Clinical features features of severe malaria even if the initial blood Most patients have a history of recent travel to an en- tests are negative. The classical description of paroxysmal chills vere cases intensive care may be required. Examination may reveal tachycardia, pyrexia, subsequent treatment with primaquine to eradicate hypotension, pallor and in chronic cases splenomegaly. In general where there is no chloroquine resistance Complications weeklychloroquineisused. It may also lead to severe intravascular haemol- endemic area (in order to detect establish tolerance) ysis causing dark brown/black urine (blackwater fever) and should continue for 4 weeks after leaving the en- particularly after treatment with quinine. Investigations Diagnosis is by identication of parasites on thick and thin blood lms. Although the rst specimen is positive in 95% of cases at least three negative samples are re- Myelodysplastic and quired to exclude the diagnosis. The thick lm is more myeloproliferative disorders sensitive for diagnosis and the thin lm is used to dif- ferentiate the parasites and quantify the percentage of Myelodysplastic syndromes parasite infected cells. Supportive therapy includes red blood cell and platelet transfusions and the use of antibiotics for infections. Al- Incidence logeneic stem cell transplantation is potentially curative 20 per 100,000 per year over the age of 70 years. These conditions have some common features: r Refractory cytopenia with multilineage dysplasia and r Extramedullary haemopoesis in the spleen and liver. Pathophysiology There may be transformation from one condition to an- The disorder arises from a single abnormal stem cell. Clinical features Patients with myelodysplastic syndrome typically present with symptoms of anaemia, thrombocytopenia Incidence (spontaneous bruising and petechiae or mucosal bleed- 1per 100,000 per year. Investigations Bone marrow aspirate examination shows normal or in- creased cellularity with megaloblastic cells and some- Sex times ring sideroblasts and abnormal myeloblasts. Almost all patients have the Philadelphia chromosome, a Cytogenetic remission is achieved in 70% of patients. Initiallythereisachronicindolentphase lasting3 5years,followedbyanacceleratedphaselasting Polycythaemia vera 6 to 18 months. Myeloid precursors and megakaryocytes may is often found from an incidental full blood count. Investigations Age r Full blood count and blood lm reveal a high neu- Most commonly presents over the age of 50 years. There may also be an increase in other gran- Sex ulocytes (basophils and eosinophils), thrombocytosis M>F and anaemia. In the chronic phase blast cells account for <10% of peripheral white blood cells. Idiopathicdisorder,althoughgeneticandenvironmental r Bone marrow aspirate shows a hypercellular marrow factors have been suggested. Polycythemia results in increased Management blood viscosity increasing the risk of arterial or venous r Hydroxyurea can induce a haematologic remission thrombosis.

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On the role conflict between the physician as adviser and the physician as scientist see Eliot Freidson order procyclidine with visa symptoms acid reflux, Professional Dominance: The Social Structure of Medical Care (Chicago: Aldine purchase cheap procyclidine online medications you can take while breastfeeding, 1972) buy generic procyclidine canada symptoms 97 jeep 40 oxygen sensor failure. The reviewers foresee an imminent antiscientific backlash from the general public when the evidence provided by Sternglass becomes generally known. The public will come to feel it has been lulled into a sense of security by the unfounded optimism of the spokesmen for scientific institutions regarding the threat constituted by low-level radiation. The reviewers argue for policy research to prevent such a backlash and to protect the scientific community from its consequences. This difficulty has been partially overcome by the assembly of separate bibliographies. See also The Sources of Health: An Annotated Bibliography of Current Research Regarding the Non-therapeutic Determinants of Health, Center for Urban Affairs, Northwestern University (Evanston, Ill. Engel, "A Unified Concept of Health and Disease," Perspectives in Biology and Medicine 3 (summer I960): 459-85. He calls for a fourth category in the conceptual tools of modern medicine: the recognition of breakdown. First it was discovered that disease could be prevented by environmental public health measures, especially by exerting control over supplies of food and water. The second breakthrough came with the concept of immunization, preparing the individual for resistance. A third breakthrough came with the recognition of multiple causation: one succumbs to a given disease when a given agent interacts with a given host in a given environment; the task of medicine is to recognize and control these givens. Antonovsky suggests the ulterior concept of breakdown, and a definition that permits this global concept to be made operational. For the author, "a radically new question arises: what is the aetiology of breakdown? Is there some new constellation of factors which is a powerful predictor of breakdown? At which point does the physician turn into the unethical accomplice of a destructive environment? Begelman, "The Ethics of Behavioral Control and a New Mythology," Psychotherapy 8, no. On hubris calling forth nemesis, see David Grene, Greek Political Theory: The Image of Man in Thucydides and Plato (Chicago: Univ. The granting of self-government is a delegation of legislative and judicial functions that can be justified only as a safeguard to public interests. Yet, it is the unique combinations of these sectors that give a place its distinct character and asset base. Creative Minds in Medicine explores the intersections that are taking place between the arts1 and culture and health and human services sectors. The publication reveals how these resourceful collaborations are improving health and wellness outcomes for the broader community as well as serving individual needs. We believe you will have new insights and appreciation for the invaluable contributions produced when arts and health professionals join forces for our community now and in the future. Both of these sectors were formed in response to the industrialization of Cleveland s economy, which grew rapidly during the 19th and 20th centuries, greatly increasing the area s urban population and fnancial resources. With those resources, wealthy industrialists funded the development and endowment of numerous cultural organizations, greatly improving quality of life for the growing numbers of Cleveland residents. The resulting growth of the local healthcare industry led to advances in medicine and the establishment of boards of health and other certifcation agencies which, in turn, promoted the creation of more health education resources. These assets, along with Cleveland s location on key transportation routes, helped the city s medical community grow into one of the most notable metropolitan healthcare sectors in the world. Meanwhile, Cleveland s arts and culture institutions have multiplied in number and discipline, expanded in size and reputation, and become renowned attractions for local and international audiences. While Cleveland is known for the strength of its arts and culture and health and human services sectors, the intersections of those sectors are still being explored and developed. This white paper examines the concept of such intersections frst with a brief historical perspective on the development of the feld. The organization of subsequent chapters is based on a number of examples of real-life programs and practices, both national and local, which illustrate the many ways in which arts and culture contribute to healthcare practice and human services delivery: Arts integration in healthcare environments. The infusion of arts and culture in, or the design of, settings where healthcare and medical treatment are given to individuals. The engagement of individuals and communities in arts and culture activities and therapies for the promotion of broader clinical and general wellness outcomes. The ability of arts and culture to strengthen social ties and serve as a rallying point from which communities can address public health and social equity issues. The enrichment of medical training programs through the integration of arts and culture. The fnal sections of the paper introduce best practices and policy recommendations to further strengthen Cleveland s arts and health intersections in the future. Community Partnership for Arts and Culture 5 Creative Minds in Medicine Executive Summary The Historical Development of the Arts and Health Field Throughout history, doctors and medical personnel have provided care of patients and treatment of disease. They have worked to apply scientifc methods in light of and sometimes in spite of the different cultural conditions of the period and location in which they work. The tension between the twin concerns of comfort and science has pulled prevailing medical and social thought frst one way and then another over the years. This has occurred primarily as clinical approaches based in science, diagnosis of disease and observation have competed for favor with more humanistic approaches that emphasize individualized care, compassionate doctor/patient interactions and patient empowerment in healthcare decision-making. The patient-centric approach with its stronger connection to the social sciences has emerged more recently, following a period of stricter emphasis on disease-based, standardized treatment in the vein of natural sciences methodology. Over the past 50 years, greater acceptance of whole person healthcare practices, which consider each patient s unique needs, have created fertile ground for the application of arts and culture activities and expressive arts therapies in health and wellness. Over the course of the 20th century, professional psychologists and educators played an important role in integrating the arts with health more fully. And, from the mid-to late 20th century, greater institutional supports for the arts and health intersection began to develop, while today emphasis is being placed on the production of evidence-based research that demonstrates the multiple values of the intersection. Arts Integration in Healthcare Environments Healthcare facilities can range from small neighborhood clinics to huge hospital campuses. Whatever the type of facility, design considerations are typically focused on creating environments that welcome patients and their families, ease navigation to destinations and facilitate positive general wellness and therapeutic outcomes. Florence Nightingale, the founder of modern nursing, was one of the earliest practitioners of medicine that tied a patient s environment to his or her health results. Discussions about healthcare environments have continued to include the roles of such factors, with growing emphasis placed on the specifc parts that arts and culture can play from two key perspectives: the infusion of works of art and performances into healthcare spaces; and the specifc role the design feld plays in healthcare environments from structural, aesthetic and practical viewpoints. Over time, arts and culture have come to be valued for more than their decorative uses and are increasingly being integrated with healthcare environments for therapeutic ends. With key partnerships developing between Cleveland s wealth of arts and culture organizations and its healthcare institutions, more visual artworks and performances are appearing in healthcare settings such as the Cleveland Clinic, MetroHealth and University Hospitals. Additionally, design considerations are directly infuencing health and well-being with medical products shaped by organizations including Nottingham Spirk and Smartshape; biomedical art and game applications from students at the Cleveland Institute of Art; specially designed fashion from businesses such as Downs Designs; and architectural elements in facilities like the Hospice of the Western Reserve. Research has shown that arts integration in healthcare environments can yield lower levels of stress and the use of pain medication among patients; reduce medical errors and work-related injuries among staff; and yield cost reductions, lower rates of staff turnover, and enhanced public perceptions of healthcare institutions/facilities.