Evaluating key performance indicators of the process of care in juvenile idiopathic arthritis.

OBJECTIVE: To determine whether and how often the information to measure a set of key performance indicators (KPIs) in juvenile idiopathic arthritis (JIA) is found in data collected routinely in a Pediatric Rheumatology Clinic. METHODS: A retrospective electronic chart review and administrative data analysis was conducted for a cohort of 140 patients with JIA at a tertiary Pediatric Rheumatology Clinic between 2016-2020. The set of KPIs include measuring patient outcomes (joint assessment, physician's global assessment of disease activity, assessment of functional ability, composite disease activity measurement), access to care (waiting time between referral and first visit, visit with the rheumatologist within the first year of diagnosis, annual follow-up visits with the rheumatologist), and safety (tuberculosis screening, and laboratory monitoring). Documentation was assessed as a binary variable indicating whether the required information was ever found. Documentation frequency for each KPI was assessed with counts and percentages of the number of times the required information was documented for each clinic visit. Compliance with the safety KPI definitions was assessed using administrative databases. RESULTS: Data for each KPI were found at least once in the cohort and documentation varied in frequency and consistency. Access to care and safety KPIs were documented more frequently than patient outcome KPIs. A joint assessment was documented at every visit for 95% of patients, 46% for an assessment of pain, and none for a physician's global assessment of disease activity, an assessment of functional ability, or a composite disease activity measurement. CONCLUSION: Although feasible to measure, there is an opportunity for improving the consistency of documentation. Having an active system of monitoring KPIs and tools to simplify measurement is a key step in the process toward improved patient care outcomes. Streamlining the collection of KPI data can increase the likelihood of compliance. Next steps should involve replicating this study in various centres.

The Developing Field of Scaffold-Free Tissue Engineering for Articular Cartilage Repair.

Articular cartilage is critical for proper joint mobility as it provides a smooth and lubricated surface between articulating bones and allows for transmission of load to underlying bones. Extended wear or injury of this tissue can result in osteoarthritis, a degenerative disease affecting millions across the globe. Because of its low regenerative capacity, articular cartilage cannot heal on its own and effective treatments for injured joint restoration remain a challenge. Strategies in tissue engineering have been demonstrated as potential therapeutic approaches to regenerate and repair damaged articular cartilage. Although many of these strategies rely on the use of an exogenous three-dimensional scaffolds to regenerate cartilage, scaffold-free tissue engineering provides numerous advantages over scaffold-based methods. This review highlights the latest advancements in scaffold-free tissue engineering for cartilage and the potential for clinical translation. Impact statement Although scaffolds are often incorporated into cartilage tissue engineering strategies as a three-dimensional architecture conducive to tissue formation, scaffold-free approaches are increasingly recognized for their ability to better recapitulate the native tissue formation process. Recent advancements in scaffold-free tissue engineering and success in clinical trials demonstrate the potential of these techniques to serve as viable therapies for repairing and restoring damaged cartilage.

Improvement of thermal contact resistance by carbon nanotubes and nanofibers.

Interfacial thermal resistance results of various nanotube and nanofiber coatings, prepared by chemical vapor deposition (CVD) methods, are reported at relatively low clamping pressures. The five types of samples examined include multi-walled and single-walled nanotubes growth by CVD, multi-walled nanotubes grown by plasma enhanced CVD (PECVD) and carbon nanofibers of differing aspect ratio grown by PECVD. Of the samples examined, only high aspect ratio nanofibers and thermally grown multi-walled nanotubes show an improvement in thermal contact resistance. The improvement is approximately a 60% lower thermal resistance than a bare Si-Cu interface and is comparable to that attained by commercially available thermal interface materials.