Putting patients at the center of kidney care transitions: PREPARE NOW, a cluster randomized controlled trial

Care for patients transitioning from chronic kidney disease to kidney failure often falls short of meeting patients' needs. The PREPARE NOW study is a cluster randomized controlled trial studying the effectiveness of a pragmatic health system intervention, 'Patient Centered Kidney Transition Care,' a multi-component health system intervention designed to improve patients' preparation for kidney failure treatment. Patient-Centered Kidney Transition Care provides a suite of new electronic health information tools (including a disease registry and risk prediction tools) to help providers recognize patients in need of Kidney Transitions Care and focus their attention on patients' values and treatment preferences. Patient-Centered Kidney Transition Care also adds a 'Kidney Transitions Specialist' to the nephrology health care team to facilitate patients' self-management empowerment, shared-decision making, psychosocial support, care navigation, and health care team communication. The PREPARE NOW study is conducted among eight [8] outpatient nephrology clinics at Geisinger, a large integrated health system in rural Pennsylvania. Four randomly selected nephrology clinics employ the Patient Centered Kidney Transitions Care intervention while four clinics employ usual nephrology care. To assess intervention effectiveness, patient reported, biomedical, and health system outcomes are collected annually over a period of 36 months via telephone questionnaires and electronic health records. The PREPARE NOW Study may provide needed evidence on the effectiveness of patient-centered health system interventions to improve nephrology patients' experiences, capabilities, and clinical outcomes, and it will guide the implementation of similar interventions elsewhere.

TRIAL REGISTRATION

NCT02722382.

New electrochemical techniques for probing phase transfer dynamics at dental interfaces in vitro

Phase transfer reactions such as dissolution, precipitation, sorption, and desorption are important in a wide range of processes on dental hard tissue surfaces. An overview is provided of several new complementary electrochemical techniques which are capable of probing the dynamics of such processes at solid/liquid interfaces from millimeter- to nanometer-length scales, with a variable time resolution down to the sub-millisecond level. Techniques considered include channel flow methods with electrochemical detection, which allow reactions at solid/liquid interfaces to be studied under well-defined and calculable mass transport regimes. Scanning electrochemical microscopy allows the chemical activity of interfaces to be mapped at higher spatial and temporal resolutions. This technique, which utilizes a scanning ultramicroelectrode, has been used extensively for the study of dissolution processes of ionic crystals, as well as in imaging the action of fluid-flow-blocking agents on dentin surfaces, which act via precipitation. So that interfaces at the nanometer level can be probed, an integrated electrochemical-atomic force microscope has been developed which enables the local solution conditions to be controlled electrochemically while topographical changes are mapped simultaneously.

Observed and predicted accumulation of local anaesthetic agents during continuous extradural analgesia

After lumbar extradural injections of ligocaine or etidocaine for surgical anaesthesia further accumulation in the plasma was minimal following top-up injections for pain relief after operation. The dose regimens were: 20 ml of 2% plain lignocaine HCl solution for surgical anaesthesia followed by 10 ml every 1 h until 4 h, and 20 ml of 1% plain etidocaine HCl solution for surgical anaesthesia followed by 10 ml every 2 h until 8 h. Plasma drug concentrations measured after initial doses were used to predict those following successive doses. Agreement between predicted and experimental values was good and further projections were made concerning the local accumulation of etidocaine.