Post Intensive Care Syndrome (PICS) is a recently defined constellation of findings consisting of physical, cognitive and mental health issues affecting survivors of critical illness. These are not new problems but have previously been viewed in isolation, and their prevalence unrecognized. With increasing survivorship these issues are becoming more prevalent, and with improving data sources commonalities are being identified. Two years ago the Society of Critical Medicine formed a section to focus attention on PICS. The goal is to prospectively identify those at risk and prevent/treat the sequelae of critical illness. It is now recognized that in addition to the physical and psychological toll on the patient up to 30% of family members will experience symptoms of PTSD. Surviving a critical illness is not the end of the saga, our goal must be to return patient and family to their pre-morbid condition. Co-ordinated prevention and therapy of PICS, is in its infancy, but awareness along with increasing amounts of data and study are already helping to improve outcome. This presentation will describe the syndrome, briefly cover the physical aspects, and focus on the psychological as well as some of the early interventions being utilized.
The presentation entitled ‘Genomic Medicine in the Future’ presented by Dr. Spyro Mousses will cover 5 trending innovations that are predicted to have a positive impact on pediatric healthcare over the next 25 years. The names of the selected innovations and covered topics are as follows: 1. ‘Mo’ BIG Data’ will be an overview of the trend towards generating ever more, bigger, deeper molecular data. This topic will also touch on issues related to data sharing, mobile data, longitudinal information, and the challenge of linking and integrating disparate data types. 2. ‘Reaching beyond our ken’ will address issues and challenges of transforming big data into knowledge and actionable evidence, and show examples of advanced computational systems to empower automated recovery of knowledge from disparate data types. 3. Citizen Scientist Networks will highlight the need to create human networks, where experts of all kinds can come together to solve challenging problems. The link between computational networks and human networks will be highlighted. 4. Bizarro Drug Development will highlight the reciprocal relationship between personalized medicine and clinical drug development. 5. Kids of steel will be a discussion about new models to leverage the power of all of these innovations for molecular awareness of disease risk in children, and how intelligent and evolving intervention knowledge networks can go beyond simply treating disease states, to a future of preventing the chronic conditions that plague our society before they even occur.
There’s a tricky balance for those of us who believe that the Internet can save lives. The challenge is juggling the needs for health promotion while also reflecting the realities and restrictions of current health care delivery systems. It’s time we harness the brilliance of social tools. I know that social, evolving technology will help us reduce suffering and improve health care delivery. It’s my contention that the more we leverage the lessons we learn using social tools to listen and educate patients seeking healthier lives, the more relevant science-based data and physicians will remain in improving care and the choices North Americans make when patients.
Patients’ active, thoughtful self-care and investigation online should not only be commended, it should be celebrated, integrated, and prioritized. There is a new set of responsibilities unfolding for physicians. Health care cannot and will not be limited to 15 minute-visits in the office. I’ll discuss how families seek and use health information online, how physician-communities are changing how we learn and I’ll showcase a bit of my work as a pediatrician online authoring content, using social tools, and leveraging the assets of traditional media.
We introduce a novel automated rapid prototyping method (organ printing) that allows engineering fully biological three-dimensional custom-shaped tissue and organ modules. In this technology bio-ink units (multicellular aggregates) composed of single or several cell types together with supporting material are delivered by special printers. Printing of the bio-ink units (controlled by architectural software) is carried out according to a design template, consistent with the geometry and composition of the desired organ module. Structure formation occurs by the post-printing fusion of the discrete bio-ink units. When the bio-ink units contain more than one cell type, fusion is accompanied by sorting of the cells into the physiologically relevant pattern. Thus structure formation takes place through self-assembly processes akin to those utilized in early embryonic morphogenesis. We demonstrate the technology by detailing the construction of tubular organ modules. Vascular grafts and nerve grafts are examples of such organ modules. Spherical and cylindrical bio-ink units have been employed to build fully biological linear and branching vascular tubular conduits and multiluminal nerve grafts. Upon perfusion in a bioreactor the constructs achieved desirable biomechanical and biochemical properties that allowed implantation into animal models.
Despite these successes, building functional full organs, such as liver, kidney, heart by bioprinting or by any other tissue or organ engineering technology is not an imminent solution for the chronic shortage of donor organs. Instead of solely concentrating on organs recent bioprinting activity has focused rather on the building of anatomically correct, functional tissues that could be employed for drug screening and development. Such tissues built from human cells are being employed to interface early animal trials with human clinical trials in the drug development process. With increasing complexity such tissues could eventually lead to the complete elimination of animal trials and more relevant models for drugs designed for humans, resulting in significant savings and responding to the growing concern about harm caused to animals. As such tissues are prepared from autologous sources they open the door to the ultimate patient tailored drug development process: multiple identical copies of the engineered tissue can be used for different formulations of the drug until the optimal one for the patient if found. In addition, these tissues can also be used for toxicology assays, again in a patient tailored manner further potentially mitigating the risks, associated with adverse side effects.
In summary, our results show that the printing of conveniently prepared cellular units is feasible and represents a promising tissue and organ engineering technology with multiple applications of great significance.