Papers by Carlos Antonio Marquez Estrada
Journal of Tissue Engineering, 2014
Plos One, Mar 14, 2014
Acellular scaffolds derived from Bombyx mori silk fibroin were investigated for their ability to ... more Acellular scaffolds derived from Bombyx mori silk fibroin were investigated for their ability to support functional tissue regeneration in a rabbit model of urethra repair. A bi-layer silk fibroin matrix was fabricated by a solvent-casting/salt leaching process in combination with silk fibroin film casting to generate porous foams buttressed by homogeneous silk fibroin films. Ventral onlay urethroplasty was performed with silk fibroin grafts (Group 1, N = 4) (Width6Length, 162 cm 2 ) in adult male rabbits for 3 m of implantation. Parallel control groups consisted of animals receiving small intestinal submucosa (SIS) implants (Group 2, N = 4) or urethrotomy alone (Group 3, N = 3). Animals in all groups exhibited 100% survival prior to scheduled euthanasia and achieved voluntary voiding following 7 d of initial catheterization. Retrograde urethrography of each implant group at 3 m post-op revealed wide urethral calibers and preservation of organ continuity similar to preoperative and urethrotomy controls with no evidence of contrast extravasation, strictures, fistulas, or stone formation. Histological (hematoxylin and eosin and Masson's trichrome), immunohistochemical, and histomorphometric analyses demonstrated that both silk fibroin and SIS scaffolds promoted similar extents of smooth muscle and epithelial tissue regeneration throughout the original defect sites with prominent contractile protein (a-smooth muscle actin and SM22a) and cytokeratin expression, respectively. De novo innervation and vascularization were also evident in all regenerated tissues indicated by synaptophysin-positive neuronal cells and vessels lined with CD31 expressing endothelial cells. Following 3 m post-op, minimal acute inflammatory reactions were elicited by silk fibroin scaffolds characterized by the presence of eosinophil granulocytes while SIS matrices promoted chronic inflammatory responses indicated by mobilization of mononuclear cell infiltrates. The results of this study demonstrate that bi-layer silk fibroin scaffolds represent promising biomaterials for onlay urethroplasty, capable of promoting similar degrees of tissue regeneration in comparison to conventional SIS scaffolds, but with reduced immunogenicity.
Http Dx Doi Org 10 1080 10401334 2012 741543, 2013
The psychometric properties of evaluations at academic meetings have not been well studied. To ex... more The psychometric properties of evaluations at academic meetings have not been well studied. To explore the ceiling effect in the evaluation of quality of a professional meeting and whether a change in the scale labels would decrease the ceiling effect. Cross-sectional study at two national meetings (2009-2010), attendees completed the evaluation on paper forms or online (5-point Likert scale). Of 1,064 evaluations, the mean session ratings was higher among respondents to the paper version in 2009 (4.2; 95% confidence interval [CI], 4.1 to 4.3) as compared to online responders in 2009 (3.0; 95% CI, 2.9 to 3.1) or online responders in 2010 (3.0; 95% CI, 2.9 to 3.1)(p < 0.001). A ceiling effect was present in the evaluation of an academic meeting. A change in the evaluation scale labels decreased the ceiling effect and increased evaluation variability.
The American Journal of Medicine, Feb 1, 1996
Journal of Investigative Medicine, 2007
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The American Journal of the Medical Sciences
Little empirical evidence is available in the medical field defining the most important features ... more Little empirical evidence is available in the medical field defining the most important features of a scientific presentation. We sought to empirically identify what features of a scientific oral presentation experienced reviewers focus on when asked to identify the best features and areas to improve. Observational study of 44 presenters at a scientific meeting over a 4-year period. Reviewers observed presenters and identified the best features and made suggestions for improvement using an open-ended form. We developed a coding form based on three domains: content, slides, and presentation style. Two raters blinded to the presenter then coded the comments, and disagreement was resolved by concurrent review. Reviewers made at least one comment about content in 42 (95.5%) of the presentations, about slides in 38 (86.4%), and about presentation style in 42 (95.5%). The most frequently extracted comments on best features of presentations in the domain "content" were identifyin...
The American Journal of the Medical Sciences
The ability to use printed material to function in society (literacy) and to handle basic numeric... more The ability to use printed material to function in society (literacy) and to handle basic numerical concepts (numeracy) may have implications in patients' ability to follow dosing schedules. We examined literacy and numeracy skills among patients on warfarin and explored their association with anticoagulation control. Patients older than 50 years attending two anticoagulation management units were prospectively enrolled. We measured literacy, numeracy, and international normalized ratio (INR). During a 3-month follow-up period, we calculated the variability of the INR and the amount of time a patient's INR was within his or her therapeutic range, variables associated with bleeding and effectiveness. Among 143 patients, only 75 (52.4%) were able to read health-related words at the eighth grade level or less. Patients' self-reported grade completed was higher than the measured literacy grade level (kappa = 0.21). While 79.0% had completed at least eight grades, only 47.6% ...
The Annals of Thoracic Surgery
The association between perioperative hyperglycemia and outcomes in patients with and without dia... more The association between perioperative hyperglycemia and outcomes in patients with and without diabetes mellitus undergoing coronary artery bypass grafting is not well defined. We measured the association between perioperative hyperglycemia and outcomes among patients undergoing coronary artery bypass grafting. We report a historic cohort study of 1574 patients who had undergone coronary artery bypass grafting between 1998 and 1999, 545 (34.6%) with diabetes. Perioperative blood glucose level was defined as the average of all blood glucose tests obtained on the day of and the day after surgery. Outcomes were 30-day mortality, infection rates (sternum, harvest site, sepsis, pneumonia, urinary tract), and resource utilization. After adjusting for diabetes status and calculated preoperative mortality or mediastinitis risk scores, each 50 mg/dL (2.78 mmol/L) blood glucose increase was not statistically associated with higher mortality (odds ratio 1.37; 95% confidence interval, 0.98 to 1....
American Journal of Medical Quality
The purpose of this research was to provide insight into the use of existing administrative data ... more The purpose of this research was to provide insight into the use of existing administrative data and to identify changes that could be made to improve broad-based use of administrative data. Data were collected on patients hospitalized with pneumonia at a 715 bed hospital in North Carolina in 1996-1997. Patients were selected from administrative databases via diagnosis and charge codes. Outcome variables were length of stay and total hospital charges. Explanatory variables were age, sex, race, insurance type, season of year, admission source (emergency department or other), comorbidity score, care path designation, physician specialty and teaching appointment. These data were collected from administrative data and then from a limited chart review to correct the administrative data. We found no significant differences in economic outcomes between the administrative data and the corrected administrative data. Administrative data appear to be a reliable and cost-effective data source f...
Journal of Continuing Education in the Health Professions
Introduction: Physician use of the Internet for practice improvement has increased dramatically o... more Introduction: Physician use of the Internet for practice improvement has increased dramatically over the last decade, but research shows that many physicians choose not to participate. The current study investigated the association of specific physician characteristics with enrollment rates and intensity of participation in a specific Internet-delivered educational intervention to improve care to post–myocardial infarction (MI) patients.Methods: Primary-care physicians were recruited for participation in a randomized controlled trial designed to compare effectiveness of an intervention Web site versus a control Web site in the management of adult chronic disease. Physicians were informed that the intervention focused on ambulatory post–myocardial infarction patients. Physician characteristics were obtained from a commercial vendor with data merged from the American Medical Association and Alabama State Licensing Board. Enrollment and Web use were tracked electronically.Results: Out ...
Annals of internal medicine, Jan 17, 2015
Effective clinical practice : ECP
Although observational studies suggest that clinical pathways may decrease costs and improve qual... more Although observational studies suggest that clinical pathways may decrease costs and improve quality in hospitalized patients with community-acquired pneumonia, inferences from these studies are limited by potential selection bias and inadequate case-mix adjustment. To compare the assessment of a clinical pathway for community-acquired pneumonia with and without adjusting for patient characteristics and disease severity. Retrospective cohort study. Consecutive series of adult patients admitted with clinical diagnosis of community-acquired pneumonia, treated with either a clinical pathway (which included guidelines for antibiotics, tests, and ancillary care) or usual care. Total hospital charges, length of stay, clinical deterioration (requiring mechanical ventilation or intensive care unit transfer), and in-hospital mortality. We used multiple linear and logistic regression to adjust for patient case mix. Compared with patients receiving usual care (n = 275), patients in the pathway...
BMJ (Clinical research ed.)
American journal of medical quality : the official journal of the American College of Medical Quality
The purpose of this research was to provide insight into the use of existing administrative data ... more The purpose of this research was to provide insight into the use of existing administrative data and to identify changes that could be made to improve broad-based use of administrative data. Data were collected on patients hospitalized with pneumonia at a 715 bed hospital in North Carolina in 1996-1997. Patients were selected from administrative databases via diagnosis and charge codes. Outcome variables were length of stay and total hospital charges. Explanatory variables were age, sex, race, insurance type, season of year, admission source (emergency department or other), comorbidity score, care path designation, physician specialty and teaching appointment. These data were collected from administrative data and then from a limited chart review to correct the administrative data. We found no significant differences in economic outcomes between the administrative data and the corrected administrative data. Administrative data appear to be a reliable and cost-effective data source f...
Journal of the National Medical Association, 2010
This paper highlights a descriptive study of the challenges and lessons learned in the recruitmen... more This paper highlights a descriptive study of the challenges and lessons learned in the recruitment of rural primary care physicians into a randomized clinical trial using an Internet-based approach. A multidisciplinary/multi-institutional research team used a multilayered recruitment approach, including generalized mailings and personalized strategies such as personal office visits, letters, and faxes to specific contacts. Continuous assessment of recruitment strategies was used throughout study in order to readjust strategies that were not successful. We recruited 205 primary care physicians from 11 states. The 205 lead physicians who enrolled in the study were randomized, and the overall recruitment yield was 1.8% (205/11231). In addition, 8 physicians from the same practices participated and 12 nonphysicians participated. The earlier participants logged on to the study Web site, the greater yield of participation. Most of the study participants had logged on within 10 weeks of th...
Journal of the National Medical Association, 2011
Even though pay-for-performance programs are being rapidly implemented, little is known about how... more Even though pay-for-performance programs are being rapidly implemented, little is known about how patient complexity affects practice-level performance assessment in rural settings. We sought to determine the association between patient complexity and practice-level performance in the rural United States. Using baseline data from a trial aimed at improving diabetes care, we determined factors associated with a practice's proportion of patients having controlled diabetes (hemoglobin A1c<or=7%): patient socioeconomic factors, clinical factors, difficulty with self-testing of blood glucose, and difficulty with keeping appointments. We used linear regression to adjust the practice-level proportion with A1c controlled for these factors. We compared practice rankings using observed and expected performance and classified practices into hypothetical pay-for-performance categories. Rural primary care practices (n=135) in 11 southeastern states provided information for 1641 patients w...
BMJ open, 2012
To determine the effectiveness of a provider-based intervention to improve medication intensifica... more To determine the effectiveness of a provider-based intervention to improve medication intensification among patients with diabetes. Effectiveness cluster-randomised trial. Baseline and follow-up cross-sections of diabetes physicians' patients. Eleven U.S. Southeastern states, 2006-2008. 205 Rural primary care physicians, 95 completed the study. Multicomponent interactive intervention including web-based continuing medical education (CME), performance feedback and quality improvement tools. Medication intensification, a dose increase of an existing medication or the addition of a new class of medication for glucose, blood pressure and lipids control on any of the three most recent office visits. Of 364 physicians attempting to register, 102 were randomised to the intervention and 103 to the control arms; 95 physicians (intervention, n=48; control, n=47) provided data on their 1182 of their patients at baseline (intervention, n=715; control, n=467) and 945 patients at follow-up (i...
Journal of graduate medical education, 2012
Providing high-quality teaching to residents during attending rounds is challenging. Reasons incl... more Providing high-quality teaching to residents during attending rounds is challenging. Reasons include structural factors that affect rounds, which are beyond the attending's teaching style and control. To develop a new evaluation tool to identify the structural components of ward rounds that most affect teaching quality in an internal medicine (IM) residency program. The authors developed a 10-item Ecological Momentary Assessment (EMA) tool and collected daily evaluations for 18 months from IM residents rotating on inpatient services. Residents ranked the quality of teaching on rounds that day, and questions related to their service (general medicine, medical intensive care unit, and subspecialty services), patient census, absenteeism of team members, call status, and number of teaching methods used by the attending. Residents completed 488 evaluation cards over 18 months. This found no association between perceived teaching quality and training level, team absenteeism, and call ...
Journal of general internal medicine, Jan 21, 2015
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Papers by Carlos Antonio Marquez Estrada