An Innovative Stereolithography 3D Tubular Method for Ultrathin Polymeric Stent Manufacture: The Effect of Process Parameters.

In the last decades, researchers have been developing bioresorbable stents (BRS) to overcome the long-term complications of drug-eluting stents (DES). However, BRS technology still presents challenging limitations in terms of manufacturing, materials, or mechanical properties. At this juncture, companies have developed ultrathin DES that may further improve the efficacy and safety profile of traditional DES by reducing the risk of target-lesion and target-vessel failures until BRS are developed. Nonetheless, the metallic platform of ultrathin DES still presents problems related to their cellular response. The use of polymers as a permanent platform in DES has not previously been studied due to the limitations of current manufacturing technologies. In this work, an innovative manufacturing method for polymeric stent production using tubular stereolithography (SLA) technology is proposed both for BRS and for ultrathin polymeric DES. The effects of manufacturing process parameters were studied by modelling the outcomes (stent thickness and strut width) with the key manufacturing variables (exposure, resin volume, and number of layers). Two different laser setups were used to compare the results. Microscopy results proved the merit of this novel tubular SLA process, which was able to obtain stents with 70 µm strut width and thickness in barely 4 min using only 0.2 mL of resin. Differential Scanning Calorimetry (DSC) results showed the stability of the manufacturing method. The results obtained with this innovative technology are promising and overcome the limitations of other previously used and available technologies.

Effectiveness of the Epley manoeuvre in posterior canal benign paroxysmal positional vertigo: a randomised clinical trial in primary care.

BACKGROUND: Evidence on the effectiveness of the Epley manoeuvre in primary care is scarce. AIM: To evaluate effectiveness at 1 week, 1 month, and 1 year of a single Epley manoeuvre versus a sham manoeuvre in primary care. DESIGN AND SETTING: Multicentre, double-blind randomised controlled trial in two primary care practices in Spain from November 2012 to January 2015. METHOD: Patients were ≥18 years diagnosed with subjective or objective posterior benign paroxysmal positional vertigo (vertigo only, or vertigo and nystagmus after a Dix-Hallpike test [DHT]). The intervention group received the Epley manoeuvre, and the control group received a sham manoeuvre. Betahistine was prescribed following the same regimen in both groups. The main outcome measures were the DHT result classified as negative (neither vertigo nor nystagmus) or positive. Positive results were further divided into a positive result for both vertigo and nystagmus (positive DHT with nystagmus), and a positive result for vertigo only (positive DHT without nystagmus); self-reported resolution of vertigo; and self-reported severity of vertigo evaluated on a 10-point Likert scale (10 = worst imaginable vertigo). RESULTS: In total, 134 patients were randomised to either the intervention group (n = 66) or the sham group (n = 68). The intervention group showed better results in the unadjusted analyses at 1 week, with a lower rate of positive DHT with nystagmus (P = 0.022). A positive baseline DHT with nystagmus was associated with a reduction in vertigo severity (marginal effect for 10-point Likert-like question -1.73, 95% confidence interval [CI] = -2.95 to -0.51) and better positive DHT rates in the intervention group (adjusted odds ratio 0.09, 95% CI = 0.01 to 0.92) in the multivariate analyses. CONCLUSION: A single Epley manoeuvre performed in primary care is an effective treatment for reversing a positive DHT and reducing vertigo severity in patients with baseline nystagmus in the DHT.

Hand-held cardiac ultrasound screening performed by family doctors with remote expert support interpretation.

OBJECTIVE: To assess the usefulness of hand-held cardiac ultrasound (HCU) performed by family doctors (FDs) in primary care, with web-based remote expert support interpretation, in a cohort of patient with symptoms or physical examination signs suggestive of cardiovascular disease. METHODS: This prospective observational study included 1312 consecutive patients, in three remote primary care areas, with symptoms or physical examination signs suggestive of cardiovascular disease. In 859 patients (group A), FDs had indicated conventional echocardiography (CE), and in 453 (Group B) the study was performed to complement the physical examination. HCU was carried out by 14 FDs after a short training period. The scans and preliminary FD reports were uploaded on a web-based program for remote expert support interpretation in <24 h. RESULTS: Experts considered HCU to be inconclusive in 116 (8.8%) patients. FD and expert agreement on diagnosis was moderate (K=0.40-0.70) except in mitral stenosis (K=0.29) and in left atrial dilation (K=0.38). Diagnostic agreement between expert interpretation and CE was good (K=0.66-0.85) except in mitral stenosis (K=0.43). After remote expert interpretation, conventional echocardiograms were finally requested by FDs in only 276 (32.1%) patients, and discharges increased by 10.2%. Furthermore, significant heart diseases were diagnosed in 32 (7%) patients of group B. CONCLUSIONS: HCU performed at the point of care by FDs with remote expert support interpretation using a web-based system is feasible, rapid and useful for detecting significant echocardiographic abnormalities and reducing the number of unnecessary echocardiographic studies.

Variabilidad en la realización de la espirometría y sus consecuencias en el tratamiento de la EPOC en Atención Primaria / Variability in the Performing of Spirometry and Its Consequences in the Treatment of COPD in Primary Care

Antecedentes: Algunos estudios han abordado el uso de la espirometría en la enfermedad pulmonarobstructiva crónica (EPOC) en Atención Primaria (AP), y pocos han analizado su impacto en el tratamientodel paciente con EPOC.Objetivos: Valorar la utilización de la espirometría en el diagnóstico y seguimiento de los pacientes EPOCen AP y su impacto en el tratamiento. Analizar la variabilidad en la realización de espirometrías entre loscentros de AP.Metodología: Estudio multicéntrico, observacional y transversal en pacientes EPOC atendidos en AP deCatalunya (España) durante 2004-2005. Se usó un modelo de regresión logística multinivel para identificarfactores asociados con tener espirometría y determinar la variabilidad entre los diferentes centros.Resultados: Participaron 21 centros, que incluyeron 801 pacientes. Solo el 53,2% disponían de espirometríadiagnóstica, la media (desviación estándar) del FEV1(%) fue 54,8% (18%). Los registros del hábitotabáquico, pruebas complementarias y espirometrías de seguimiento estuvieron más presentes entre lospacientes que disponían de espirometría diagnóstica respecto a aquellos que no la disponían.Nose encontrarondiferencias estadísticamente significativas respecto a variables demográficas, clínicas, tratamientoy calidad de vida entre pacientes con o sin espirometría de seguimiento. Se observó variabilidad significativaen el porcentaje de espirometrías diagnósticas entre los diferentes centros de AP (varianza = 0,217;p < 0,001).Conclusión: La espirometría en AP está infrautilizada y su realización durante el seguimiento no se asocia aunas pautas distintas de tratamiento ni a un abordaje más completo de la enfermedad. Existe variabilidadsignificativa en la realización de espirometrías entre los centros de AP(AU)

Background: Several studies have approached the use of spirometry in the treatment of chronic obstructivepulmonary disease (COPD) in Primary Care (PC), but few have analysed its impact on the treatmentof the patient with COPD.Objectives: To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, andits impact on treatment. To analyse the variation in the performing of spirometry between PC centres. Methodology: A multicentre, observational and cross-sectional study of COPD patients seen in PC inCatalonia (Spain) during 2004–2005. A multilevel logistic regression model was used to identify factorsassociated with having spirometry and to determine the variation between the different centres.Results: Twenty-one centres which included 801 patients took part. Only 53.2% of them had a diagnosticspirometer available and themean(standard deviation) FEV1(%) was 54.8% (18%). The registers of smokinghabits, complementary tests and spirometry follow-up were more common among patients who had adiagnostic spirometry available compared to those who did not. No statistically significant differenceswere found as regards demographic, clinical, treatment and quality of life variables between patientswith and without follow-up spirometry. Significant variation was observed in the percentage of diagnosticspirometries between different PC centres (variance = 0.217; p < 0.001).Conclusion: Spirometry is underused in PC and performing it during follow-up is not associated to thedifferent treatments received, or with a more complete approach to the disease. There is significantvariation in the performing of spirometry among PC centres(AU)

Variability in the performing of spirometry and its consequences in the treatment of COPD in primary care.

BACKGROUND: Several studies have approached the use of spirometry in the treatment of chronic obstructive pulmonary disease (COPD) in Primary Care (PC), but few have analysed its impact on the treatment of the patient with COPD. OBJECTIVES: To evaluate the use of spirometry in the diagnosis and follow-up of COPD patients in PC, and its impact on treatment. To analyse the variation in the performing of spirometry between PC centres. METHODOLOGY: A multicentre, observational and cross-sectional study of COPD patients seen in PC in Catalonia (Spain) during 2004-2005. A multilevel logistic regression model was used to identify factors associated with having spirometry and to determine the variation between the different centres. RESULTS: Twenty-one centres which included 801 patients took part. Only 53.2% of them had a diagnostic spirometer available and the mean (standard deviation) FEV1(%) was 54.8% (18%). The registers of smoking habits, complementary tests and spirometry follow-up were more common among patients who had a diagnostic spirometry available compared to those who did not. No statistically significant differences were found as regards demographic, clinical, treatment and quality of life variables between patients with and without follow-up spirometry. Significant variation was observed in the percentage of diagnostic spirometries between different PC centres (variance=0.217; p<0.001). CONCLUSION: Spirometry is underused in PC and performing it during follow-up is not associated to the different treatments received, or with a more complete approach to the disease. There is significant variation in the performing of spirometry among PC centres.