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[PMID]: 25925683
[Au] Autor:Morrison RJ; Hollister SJ; Niedner MF; Mahani MG; Park AH; Mehta DK; Ohye RG; Green GE
[Ad] Address:Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA....
[Ti] Title:Mitigation of tracheobronchomalacia with 3D-printed personalized medical devices in pediatric patients.
[So] Source:Sci Transl Med;7(285):285ra64, 2015 Apr 29.
[Is] ISSN:1946-6242
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Three-dimensional (3D) printing offers the potential for rapid customization of medical devices. The advent of 3D-printable biomaterials has created the potential for device control in the fourth dimension: 3D-printed objects that exhibit a designed shape change under tissue growth and resorption conditions over time. Tracheobronchomalacia (TBM) is a condition of excessive collapse of the airways during respiration that can lead to life-threatening cardiopulmonary arrests. We demonstrate the successful application of 3D printing technology to produce a personalized medical device for treatment of TBM, designed to accommodate airway growth while preventing external compression over a predetermined time period before bioresorption. We implanted patient-specific 3D-printed external airway splints in three infants with severe TBM. At the time of publication, these infants no longer exhibited life-threatening airway disease and had demonstrated resolution of both pulmonary and extrapulmonary complications of their TBM. Long-term data show continued growth of the primary airways. This process has broad application for medical manufacturing of patient-specific 3D-printed devices that adjust to tissue growth through designed mechanical and degradation behaviors over time.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[St] Status:In-Data-Review
[do] DOI:10.1126/scitranslmed.3010825

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[PMID]: 25876624
[Au] Autor:Zhou B; Ren J; Li J; Guo A; Cao X; Chang J
[Ad] Address:Department of General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
[Ti] Title:[Regenerative surgery: promises, strategies, and translational perspectives].
[So] Source:Zhonghua Wai Ke Za Zhi;53(1):72-6, 2015 Jan 1.
[Is] ISSN:0529-5815
[Cp] Country of publication:China
[La] Language:chi
[Ab] Abstract:Regenerative surgery is an emerging multidisciplinary field that has the potential to transform the surgical treatment for diseases and injuries. This article provides a brief overview of the history of surgery and regenerative medicine, introduces the new concept of regenerative surgery, describes the surgical procedures, and discusses the role of surgeons in developing and implementing these technologies. Insights gained from recent clinical research of regenerative medicine are beginning to yield three strategies for regenerative therapies for surgical diseases, and this review also provides the challenges and translational perspectives of these different strategies.
[Mh] MeSH terms primary: General Surgery/trends
Regenerative Medicine
[Mh] MeSH terms secundary: Biomedical Research
Humans
[Pt] Publication type:ENGLISH ABSTRACT; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1505
[Js] Journal subset:IM
[Da] Date of entry for processing:150416
[St] Status:MEDLINE

  3 / 1889847 MEDLINE  
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[PMID]: 25876681
[Au] Autor:Qian S; Xu F; Lu Z; Zhao X; Zhu Y
[Ad] Address:Email: syqian1211@163.com.
[Ti] Title:[Development history of Chinese pediatric critical care medicine].
[So] Source:Zhonghua Er Ke Za Zhi;53(2):93-4, 2015 Feb.
[Is] ISSN:0578-1310
[Cp] Country of publication:China
[La] Language:chi
[Mh] MeSH terms primary: Critical Care/trends
Pediatrics/trends
[Mh] MeSH terms secundary: China
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1505
[Js] Journal subset:IM
[Da] Date of entry for processing:150416
[St] Status:MEDLINE

  4 / 1889847 MEDLINE  
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[PMID]: 25876677
[Au] Autor:Ma P; Wang Y
[Ad] Address:Email: sdjnwangy@163.com.
[Ti] Title:[The development of cardiology, the Society of Pediatrics].
[So] Source:Zhonghua Er Ke Za Zhi;53(2):81-3, 2015 Feb.
[Is] ISSN:0578-1310
[Cp] Country of publication:China
[La] Language:chi
[Mh] MeSH terms primary: Cardiology/trends
Pediatrics/trends
[Mh] MeSH terms secundary: Societies, Medical/trends
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1505
[Js] Journal subset:IM
[Da] Date of entry for processing:150416
[St] Status:MEDLINE

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[PMID]: 25746509
[Au] Autor:Segall N; Hobbs G; Granger CB; Anderson AE; Bonifacio AS; Taekman JM; Wright MC
[Ad] Address:1Department of Anesthesiology, Duke University Medical Center, Durham, NC. 2Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC. 3Procurement Services, Duke University, Durham, NC. 4Trauma Program, University of North Carolina Health System, Chapel Hill, NC. 5Patient Safety Research, CHE Trinity Health and Saint Alphonsus Health System, Boise, ID.
[Ti] Title:Patient load effects on response time to critical arrhythmias in cardiac telemetry: a randomized trial.
[So] Source:Crit Care Med;43(5):1036-42, 2015 May.
[Is] ISSN:1530-0293
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVES: Remotely monitored patients may be at risk for a delayed response to critical arrhythmias if the telemetry watchers who monitor them are subject to an excessive patient load. There are no guidelines or studies regarding the appropriate number of patients that a single watcher may safely and effectively monitor. Our objective was to determine the impact of increasing the number of patients monitored on response time to simulated cardiac arrest. DESIGN: Randomized trial. SETTING: Laboratory-based experiment. SUBJECTS: Forty-two remote telemetry technicians and nurses from cardiac units. INTERVENTIONS: Number of patients monitored in a simulation of cardiac telemetry monitoring work. MEASUREMENTS AND MAIN RESULTS: We carried out a study to compare response times to ventricular fibrillation across five patient loads: 16, 24, 32, 40, and 48 patients. The simulation replicated the work of telemetry watchers using a combination of real recorded patient electrocardiogram signals and a simulated patient experiencing ventricular fibrillation. Study participants were assigned to one of the five patient loads and completed a 4-hour monitoring session, during which they performed tasks-including event documentation and phone calls to report events-similar to real monitoring work. When the simulated patient sustained ventricular fibrillation, the time required to report this arrhythmia was recorded. As patient loads increased, there was a statistically significant increase in response times to the ventricular fibrillation. In addition, frequency of failure to meet a response time goal of less than 20 seconds was significantly higher in the 48-patient condition than in all other conditions. Task performance decreased as patient load increased. CONCLUSIONS: As participants monitored more patients in a laboratory setting, their performance with respect to recognizing critical and noncritical events declined. This study has implications for the design of remote telemetry work and other patient monitoring tasks in critical and intermediate care units.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:AIM; IM
[St] Status:In-Data-Review
[do] DOI:10.1097/CCM.0000000000000923

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[PMID]: 25799940
[Au] Autor:Rosen G; Harris AK; Liu M; Dreyfus J; Krueger J; Messinger YH
[Ad] Address:Sleep Medicine, Children's Hospitals and Clinics of Minnesota, St. Paul, MN, United States. Electronic address: rosen052@umn.edu....
[Ti] Title:The effects of Dexamethasone on sleep in young children with Acute Lymphoblastic Leukemia.
[So] Source:Sleep Med;16(4):503-9, 2015 Apr.
[Is] ISSN:1878-5506
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:PURPOSE: Corticosteroids, which are a mainstay in the treatment of acute lymphoblastic leukemia (ALL), have a well-documented adverse effect on sleep. We sought to characterize the effects of dexamethasone on sleep over an entire 28-day treatment cycle using actigraphy, an objective measure of sleep. METHODS: The sleep of 25 children aged 2-9 years (mean 4.5 years) with ALL treated with dexamethasone were evaluated during maintenance chemotherapy using a within-subject experimental design, actigraphy, and standardized questionnaires to assess sleep, sleep problems, and fatigue. RESULTS: During the five days of dexamethasone treatment, sleep time increased during the night (535 vs. 498 min; p = 0.004) and daytime napping increased the following day (14 vs. 0 min; p = 0.002), and the number of wake episodes during the night was lower (14 vs. 20; p = ≤ 0.001). However, when assessed individually, sleep-onset time, efficiency, and wake after sleep onset during the night were unchanged during dexamethasone treatment; when the cumulative effect of all of these factors was assessed, there was a statistically and clinically significant increase in nighttime sleep duration during dexamethasone treatment. CONCLUSIONS: During the five days of treatment with dexamethasone, an increase in nighttime sleep as well as daytime napping was observed in young children with ALL. The increases in sleep duration return to baseline one day after the discontinuation of dexamethasone.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1504
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[St] Status:In-Data-Review

  7 / 1889847 MEDLINE  
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[PMID]: 25826420
[Au] Autor:Mocroft A; Lundgren JD; Ross M; Law M; Reiss P; Kirk O; Smith C; Wentworth D; Neuhaus J; Fux CA; Moranne O; Morlat P; Johnson MA; Ryom L; D:A:D study group; Royal Free Hospital Clinic Cohort; INSIGHT study group; SMART study group; ESPRIT study group
[Ad] Address:Department of Infection and Population Health, University College London, London, United Kingdom....
[Ti] Title:Development and validation of a risk score for chronic kidney disease in HIV infection using prospective cohort data from the D:A:D study.
[So] Source:PLoS Med;12(3):e1001809, 2015 Mar.
[Is] ISSN:1549-1676
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. METHODS AND FINDINGS: A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with ≥3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR ≤ 60 ml/min/1.73 m2. Poisson regression was used to develop a risk score, externally validated on two independent cohorts. In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1:393 chance of developing CKD in the next 5 y in the low risk group (risk score < 0, 33 events), rising to 1:47 and 1:6 in the medium (risk score 0-4, 103 events) and high risk groups (risk score ≥ 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. CONCLUSIONS: Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1504
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1371/journal.pmed.1001809

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[PMID]: 25472509
[Au] Autor:Dickinson LM; Dickinson WP; Nutting PA; Fisher L; Harbrecht M; Crabtree BF; Glasgow RE; West DR
[Ad] Address:Department of Family Medicine, University of Colorado School of Medicine, Aurora, CO, USA, miriam.dickinson@ucdenver.edu.
[Ti] Title:Practice context affects efforts to improve diabetes care for primary care patients: a pragmatic cluster randomized trial.
[So] Source:J Gen Intern Med;30(4):476-82, 2015 Apr.
[Is] ISSN:1525-1497
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Efforts to improve primary care diabetes management have assessed strategies across heterogeneous groups of patients and practices. However, there is substantial variability in how well practices implement interventions and achieve desired outcomes. OBJECTIVE: To examine practice contextual features that moderate intervention effectiveness. DESIGN: Secondary analysis of data from a cluster randomized trial of three approaches for implementing the Chronic Care Model to improve diabetes care. PARTICIPANTS: Forty small to mid-sized primary care practices participated, with 522 clinician and staff member surveys. Outcomes were assessed for 822 established patients with a diagnosis of type 2 diabetes who had at least one visit to the practice in the 18 months following enrollment. MAIN MEASURES: The primary outcome was a composite measure of diabetes process of care, ascertained by chart audit, regarding nine quality measures from the American Diabetes Association Physician Recognition Program: HgA1c, foot exam, blood pressure, dilated eye exam, cholesterol, nephropathy screen, flu shot, nutrition counseling, and self-management support. Data from practices included structural and demographic characteristics and Practice Culture Assessment survey subscales (Change Culture, Work Culture, Chaos). KEY RESULTS: Across the three implementation approaches, demographic/structural characteristics (rural vs. urban + .70(p = .006), +2.44(p < .001), -.75(p = .004)); Medicaid: < 20 % vs. ≥ 20 % (-.20(p = .48), +.75 (p = .08), +.60(p = .02)); practice size: < 4 clinicians vs. ≥ 4 clinicians (+.56(p = .02), +1.96(p < .001), +.02(p = .91)); practice Change Culture (high vs. low: -.86(p = .048), +1.71(p = .005), +.34(p = .22)), Work Culture (high vs. low: -.67(p = .18), +2.41(p < .001), +.67(p = .005)) and variability in practice Change Culture (high vs. low: -.24(p = .006), -.20(p = .0771), -.44(p = .0019) and Work Culture (high vs. low: +.56(p = .3160), -1.0(p = .008), -.25 (p = .0216) were associated with trajectories of change in diabetes process of care, either directly or differentially by study arm. CONCLUSIONS: This study supports the need for broader use of methodological approaches to better examine contextual effects on implementation and effectiveness of quality improvement interventions in primary care settings.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Entry month:1503
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1007/s11606-014-3131-3

  9 / 1889847 MEDLINE  
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[PMID]: 25179265
[Au] Autor:Pitpitan EV; Kalichman SC; Garcia RL; Cain D; Eaton LA; Simbayi LC
[Ad] Address:Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, CA, USA, epitpitan@ucsd.edu.
[Ti] Title:Mediators of behavior change resulting from a sexual risk reduction intervention for STI patients, Cape Town, South Africa.
[So] Source:J Behav Med;38(2):194-203, 2015 Apr.
[Is] ISSN:1573-3521
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Theory-based sexual risk reduction interventions are often demonstrated effective, but few studies have examined the mechanisms that mediate their behavior changes. In addition, critical contextual factors, such as alcohol use, are often not accounted for by social cognitive theories and may add to the explanatory value of intervention effects. The purpose of this study is to examine the underlying mechanisms driving condom use following a brief sexual risk reduction intervention grounded in the information, motivation, behavioral skills (IMB) model of behavior change. We examined IMB theoretical constructs and alcohol-related contextual factors as potential mediators in separate models. Patients (n = 617) from an STI clinic in Cape Town, South Africa were randomly assigned to either a brief risk reduction intervention or an education-only control condition. We assessed IMB, and alcohol-related variables at baseline, 3, 6, 9, and 12 months and modeled IMB constructs and alcohol-related factors as mediators of behavior change. Results of growth-curve mediational modeling showed that 1 year after counseling, the intervention indirectly affected sexual risk behavior through alcohol-related constructs, but not IMB constructs. Alcohol use and related factors play critical roles in explaining HIV and STI risk reduction intervention effects. Interventions that directly address alcohol use as a factor in sexual risk behavior and behavior change should be the focus of future research.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Entry month:1503
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[St] Status:In-Process
[do] DOI:10.1007/s10865-014-9591-4

  10 / 1889847 MEDLINE  
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Clinical Trials Registry
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[PMID]: 25711324
[Au] Autor:Achhra AC; Mocroft A; Ross MJ; Ryom L; Lucas GM; Furrer H; Neuhaus J; Somboonwit C; Kelly M; Gatell JM; Wyatt CM; International Network for Strategic Initiatives in Global HIV Trials (INSIGHT) START Study Group
[Ad] Address:Kirby Institute, University of New South Wales, Sydney, Australia.
[Ti] Title:Kidney disease in antiretroviral-nave HIV-positive adults with high CD4 counts: prevalence and predictors of kidney disease at enrolment in the INSIGHT Strategic Timing of AntiRetroviral Treatment (START) trial.
[So] Source:HIV Med;16 Suppl 1:55-63, 2015 Apr.
[Is] ISSN:1468-1293
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:OBJECTIVES: HIV infection has been associated with an increased risk of chronic kidney disease (CKD). Little is known about the prevalence of CKD in individuals with high CD4 cell counts prior to initiation of antiretroviral therapy (ART). We sought to address this knowledge gap. METHODS: We describe the prevalence of CKD among 4637 ART-nave adults (mean age 36.8 years) with CD4 cell counts > 500 cells/L at enrolment in the Strategic Timing of AntiRetroviral Treatment (START) study. CKD was defined by estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m(2) and/or dipstick urine protein ≥ 1+. Logistic regression was used to identify baseline characteristics associated with CKD. RESULTS: Among 286 [6.2%; 95% confidence interval (CI) 5.5%, 6.9%] participants with CKD, the majority had isolated proteinuria. A total of 268 participants had urine protein ≥ 1+, including 41 with urine protein ≥ 2+. Only 22 participants (0.5%) had an estimated glomerular filtration rate < 60 mL/min/1.73 m(2) , including four who also had proteinuria. Baseline characteristics independently associated with CKD included diabetes [adjusted odds ratio (aOR) 1.73; 95% CI 1.05, 2.85], hypertension (aOR 1.82; 95% CI 1.38, 2.38), and race/ethnicity (aOR 0.59; 95% CI 0.37, 0.93 for Hispanic vs. white). CONCLUSIONS: We observed a low prevalence of CKD associated with traditional CKD risk factors among ART-nave clinical trial participants with CD4 cell counts > 500 cells/L.
[Pt] Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Entry month:1502
[Cu] Class update date: 150516
[Lr] Last revision date:150516
[Js] Journal subset:IM
[Cl] Clinical Trial:ClinicalTrial
[St] Status:In-Process
[do] DOI:10.1111/hiv.12234


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