The Direct 3D Printing of Functional PEEK/Hydroxyapatite Composites via a Fused Filament Fabrication Approach

The manufacture of polyetheretherketone/hydroxyapatite (PEEK/HA) composites is seen as a viable approach to help enhance direct bone apposition in orthopaedic implants. A range of methods have been used to produce composites, including Selective Laser Sintering and injection moulding. Such techniques have drawbacks and lack flexibility to manufacture complex, custom-designed implants. 3D printing gets around many of the restraints and provides new opportunities for innovative solutions that are structurally suited to meet the needs of the patient. This work reports the direct 3D printing of extruded PEEK/HA composite filaments via a Fused Filament Fabrication (FFF) approach. In this work samples are 3D printed by a custom modified commercial printer Ultimaker 2+ (UM2+). SEM-EDX and µCT analyses show that HA particles are evenly distributed throughout the bulk and across the surface of the native 3D printed samples, with XRD highlighting up to 50% crystallinity and crystalline domains clearly observed in SEM and HR-TEM analyses. This highlights the favourable temperature conditions during 3D printing. The yield stress and ultimate tensile strength obtained for all the samples are comparable to human femoral cortical bone. The results show how FFF 3D printing of PEEK/HA composites up to 30 wt% HA can be achieved

Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study

<p>Abstract</p> <p>Background</p> <p>Substantial recent research examines the efficacy of many types of complementary and alternative (CAM) therapies. However, outcomes associated with the "real-world" use of CAM has been largely overlooked, despite calls for CAM therapies to be studied in the manner in which they are practiced. Americans seek CAM treatments far more often for chronic musculoskeletal pain (CMP) than for any other condition. Among CAM treatments for CMP, acupuncture and chiropractic (A/C) care are among those with the highest acceptance by physician groups and the best evidence to support their use. Further, recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain--despite their high costs, potential adverse effects, and modest efficacy--suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM treatments for CMP, which are often well accepted by patients and increasingly used in the community.</p> <p>Methods/Design</p> <p>This multi-phase, mixed methods study will: (1) conduct a retrospective study using information from electronic medical records (EMRs) of a large HMO to identify unique clusters of patients with CMP (e.g., those with differing demographics, histories of pain condition, use of allopathic and CAM health services, and comorbidity profiles) that may be associated with different propensities for A/C utilization and/or differential outcomes associated with such care; (2) use qualitative interviews to explore allopathic providers' recommendations for A/C and patients' decisions to pursue and retain CAM care; and (3) prospectively evaluate health services/costs and broader clinical and functional outcomes associated with the receipt of A/C relative to carefully matched comparison participants receiving traditional CMP services. Sensitivity analyses will compare methods relying solely on EMR-derived data versus analyses supplementing EMR data with conventionally collected patient and clinician data.</p> <p>Discussion</p> <p>Successful completion of these aggregate aims will provide an evaluation of outcomes associated with the real-world use of A/C services. The trio of retrospective, qualitative, and prospective study will also provide a clearer understanding of the decision-making processes behind the use of A/C for CMP and a transportable methodology that can be applied to other health care settings, CAM treatments, and clinical populations.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01345409">NCT01345409</a></p

La atención primaria en los Estados Unidos y la experiencia peruana en perspectiva

Due to a complex payment system, the health system of the United States is fragmented, expensive, and achieves the goal of improving the health of the entire population. Excessive health costs increase the budget deficit in the US. This situation makes to the government to have greater willingness to try new approaches in the delivery of health services. Is well know that the states that have a solid system of primary health care (PC), spent less money in diseases and have lower utilization of health services (reflected in fewer days of hospitalization). This is why the AP is spreading in the US making doctors, nurses and other providers to collaborate on new proposals for team-based care, coordinated and patient-oriented generating real benefits while controlling costs. The US experience with AP support evidence-based approach to propose, from a foreign perspective, strengthening the AP in Peru.Debido a un complejo sistema de pagos, el sistema de salud de los Estados Unidos (EE. UU.) es fragmentado, costoso, y alcanza el objetivo de mejorar la salud de toda la población. Los costos excesivos de salud incrementan el déficit económico en los EE. UU., y esto hace que su gobierno tenga mayor disposición a probar nuevos enfoques en la prestación de servicios de salud. Llama la atención que los estados norteamericanos que cuentan con un sistema de atención primaria (AP) sólido, tienen menores gastos por enfermedad y menor utilización de servicios de salud (reflejado en menos días de hospitalización). Es por esto que la AP está extendiéndose en los EE. UU., haciendo que médicos, enfermeras y otros proveedores colaboren en nuevas propuestas de atención basadas en equipo, coordinadas y orientadas al paciente generando beneficios reales, al mismo tiempo que controlan los costos. Esta experiencia estadounidense con una AP con enfoque basado en evidencias ayuda a proponer, desde una perspectiva extranjera, el fortalecimiento de la AP en el Perú

Systems of Support to Increase Colorectal Cancer (CRC) Screening –– A Randomized Trial to Increase Long-Term Adherence to CRC Screening: Time in Compliance Over 5 Years

Background: Colorectal cancer (CRC) is the second-leading cause of cancer deaths. Morbidity and mortality could be rapidly reduced through higher uptake and adherence to CRC screening. Information on longer-term screening adherence comes from organized programs that lack a comparison group. Systems of Support to Increase Colorectal Cancer Screening and Follow-Up (SOS) is an ongoing trial testing a centralized mailed and phone-based program to increase long-term CRC screening adherence. We hypothesized that, compared to usual care, intervention-arm patients would have more time in compliance with CRC screening guidelines over 5 years. Methods: Design: Individual randomized controlled trial. Setting: Integrated health care organization in Washington State. Usual care included patient-centered medical home and clinic-based interventions to increase CRC screening. Participants: 4,675 individuals initially aged 50–74, without CRC or first-degree relative with CRC before age 60, no inflammatory bowel disease, no life-limiting disease, and not current for CRC screening. All participants contributed data but were censored at disenrollment, death, age 76 or diagnosis of CRC. Interventions: Included a mailed pamphlet on CRC screening choices, a call-in number if colonoscopy was preferred and mailed fecal tests for those not choosing colonoscopy. Patients were randomly assigned in years 1 and 2 to receive this only, this plus brief telephone assistance, or both mailings and assistance and nurse navigation for those still unscreened. In year 3, intervention group participants still CRC screening-eligible were randomized to stopped or continued mailed interventions in years 3 and 5. Primary outcome (a priori): The percent of time covered for CRC screening testing over 5 years (2008–2014). Screening tests contributed covered time based on national guidelines for screening intervals (fecal tests annually, sigmoidoscopy 5 years, colonoscopy 10 years). Results: On average over 5 years, intervention participants had 224 more days of covered time, or 31% more time not in need of CRC testing (rate ratio, weighted for exposure time and adjusted relative risk 1.31 (1.25, 1.37). Fecal testing was responsible for almost all additional covered time. Conclusion: An organized mail and phone program led to increased CRC screening adherence over 5 years, mainly because of regular fecal testing uptake

The results of a 2-year randomized trial of a worksite weight management intervention.

PURPOSE: We assessed the effectiveness of a worksite management intervention (the 3W program) for overweight and obese hotel employees. DESIGN: The program was tested in a 2-year cluster-randomized trial involving 30 hotels that employed nearly 12,000 individuals. SETTING: All participating hotels were on Oahu, Hawaii. The intervention was implemented within hotel worksites. SUBJECTS: Participants were included in the analysis if they had an initial body mass index (BMI) ≥ 25, were assessed at least twice, were not missing other data needed for the analysis, and did not switch to employment at a hotel in a different experimental condition. Of the 6519 employees we assessed, data from 1207 individuals (intervention: 598; control: 610) met these criteria and contributed to the analysis. INTERVENTION: The intervention had two components: (1) group meetings and (2) a workplace environment intervention. MEASURES: Weight and waist to height ratio (WHtR) were measured at three annual assessments. ANALYSIS: The effect of the intervention on change in BMI and WHtR was estimated in hierarchical mixed regression models using full maximum likelihood to estimate model parameters. RESULTS: The effects on change in BMI and WHtR were in the expected direction but were not statistically significant. CONCLUSION: The 3W program was not effective. The low intensity of the intervention may have contributed to its ineffectiveness

An Economic Evaluation of Colorectal Cancer Screening in Primary Care Practice

Background/Aims: This study evaluated the cost-effectiveness of interventions using electronic health records (EHR), automated mailings, and stepped increases in support to improve two-year colorectal cancer screening adherence. Methods: Analyses are based on a parallel-design, randomized trial in which three stepped interventions (EHR-linked mailings [“automated”], automated plus telephone assistance [“assisted”], or automated and assisted plus nurse navigation to testing completion or refusal [“navigated”]) were compared to usual care. Data were collected over August 2008–November 2011 with analysis in 2012–2013. Implementation resources were micro-costed; research and registry development costs were excluded. Incremental cost-effectiveness ratios (ICERs) were based on number of participants current for screening per guidelines over two years. Robustness of results was examined through bootstrapping. Results: Intervention delivery cost per participant current for screening ranged from $21 (automated) to$27 (navigated). When induced testing costs (e.g. screening colonoscopy) were included, automated (ICER: -$159) and assisted (ICER: -$36) were cost-saving relative to usual care. Savings arose from increased fecal occult blood testing, substituting for more expensive colonoscopies in usual care. Results were broadly consistent across demographic subgroups. More intensive interventions were consistently likely to be cost-effective relative to less intensive interventions with willingness to pay values of $600–$1,200 for a 1% increase in the rate of screening adherence yielding probability of cost-effectiveness of at least 80%. Discussion: The cost-effectiveness was demonstrated of a stepped approach to colorectal cancer screening promotion, especially one using automated data systems linked to electronic health records