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BackgroundSubstance use disorder (SUD) is a leading contributor to the global burden of disease. In Indonesia, the availability of formal treatment for SUD falls short of the targeted coverage. A standardised therapeutic option for SUD with potential for widespread implementation is required, yet evidence-based data in the country are scarce. In this study, we developed a cognitive behavioural therapy (CBT)-based group telemedicine model and will investigate effectiveness and implementability in a multicentre randomised controlled trial.MethodsA total of 220 participants will be recruited from the social networks of eight sites in Indonesia: three hospitals, two primary healthcare centres and three rehabilitation centres. The intervention arm will participate in a relapse prevention programme called the Indonesia Drug Addiction Relapse Prevention Programme (Indo-DARPP), a newly developed 12-week module based on CBT and motivational interviewing constructed in the Indonesian context. The programme will be delivered by a healthcare provider and a peer counsellor in a group therapy setting via video-conferencing, as a supplement to participants’ usual treatments. The control arm will continue treatment as usual. The primary outcome will be the percentage increase in days of abstinence from the primarily used substance in the past 28 days. Secondary outcomes will include addiction severity, quality of life, motivation to change, psychiatric symptoms, cognitive function, coping, and internalised stigma. Assessments will be performed at baseline (week 0), post-treatment (week 13), and 3 and 12 months post-treatment completion (weeks 24 and 60). Retention, participant satisfaction, and cost-effectiveness will be assessed as the implementation outcomes.Ethics and disseminationThe study protocol was reviewed and approved by the Ethics Committees of Universitas Indonesia and Kyoto University. The results will be disseminated via academic journals and international conferences. Depending on trial outcomes, the treatment programme will be advocated for adoption as a formal healthcare-based approach for SUD.Trial registration numberUMIN000042186.

Purpose The purpose of this study is to describe the first experience of implanting a new left ventricular assist device in pediatric patients with end-stage heart failure. Description In two recent prospective, international, multicenter clinical trials, three children (aged ≤ 16 years) were implanted successfully with the VentrAssist (Ventracor Limited, Chatswood, Australia), a relatively small, novel, continuous flow, third-generation left ventricular assist device. Evaluation Despite the patients' disease severity (each child was in extremis at the time of implantation), VentrAssist (Ventracor Limited) implantation enabled each patient to be discharged home from the hospital. All patients survived for more than 1 year. One patient was successfully transplanted and another was bridged to an adequate degree of recovery; unfortunately, the third patient died on postoperative day 375 while waiting for a suitable donor heart. Consistent with the complications associated with left ventricular assist devices in adults, the main complications in these pediatric patients were infection and thromboembolism. Conclusions The VentrAssist may provide a major advancement in the management of larger children and adolescents with end-stage heart failure.

The purpose of this study was to investigate whether broadening acceptance criteria for donor hearts and changing recipient demographics resulted in an increased perioperative morbidity and mortality in a heart transplant program.Donor and recipient data of 137 consecutive heart transplants performed from 1987 to 2001 were retrospectively analyzed and divided into three equal eras, each of 5 years: 1987 to 1991, 1992 to 1996, and 1997 to 2001. Multivariate analyses of recipient and donor demographics and operative factors were performed to identify the predictors of low cardiac output, intraaortic balloon pump utilization, 30-day mortality, and duration of intensive care and hospital stay.Significant increases in number of female recipients (p = 0.025), cardiopulmonary bypass (p0.001), recipient cross-clamp (p0.001), donor age (p = 0.009), donor ischemic times (p0.001), use of cardioplegia (p0.001) and the bicaval technique (p0.001), brain death to retrieval time (p = 0.006), and need for postoperative dialysis were observed for the three study periods, whereas length of intensive care and hospital stay decreased. Female donor (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.0 to 5.7) was identified as a risk factor for low cardiac output. Female donor (OR, 3.7; 95% CI, 1.3 to 10.7), donor cardiac arrest (OR, 6.4; 95% CI, 1.6 to 25.9), and cardiopulmonary bypass time more than 2 hours (OR, 7.6; 95% CI, 2.1 to 28.1) were associated with increased intraaortic balloon pump utilization. Intensive care stay was prolonged by the biatrial technique (OR, 3.9; 95% CI, 1.3 to 11.9) and reduced by the use of cardioplegia (OR, 0.3; 95% CI, 0.1 to 0.9), longer cardiopulmonary bypass (OR, 0.2; 95% CI, 0.1 to 0.6) and aortic cross-clamp times (OR, 0.1; 95% CI, 0.03 to 0.6).Although a number of significant changes were observed during the study period, no donor, recipient, or operative factors influenced 30-day mortality. This study justifies our current donor and recipient selection policies.

Controlled hypotension is critical to the accurate deployment of aortic endografts and safe balloon post-dilation. We describe the use of rapid ventricular pacing during 15 aortic stenting procedures. An immediate and sustained reduction in both phasic and mean blood pressure was achieved in all patients. This procedure has advantages over pharmacologic or other methods of blood pressure reduction.

Acute ischaemic ventricular septal defect (VSD) is a severe complication of acute myocardial infarction. We present the unusual case of a 66-year-old man with a haemodynamically stable acute posterior basal ischemic VSD, who was managed successfully with hybrid primary coronary artery bypass grafting followed by delayed percutaneous VSD closure, with an excellent intermediate-term outcome. We feel this management strategy should be considered in selected patients with acute posterior VSDs and stable clinical status.

Ossifying fibromyxoid tumor is usually a benign tumor. However some of these tumors with histologic and clinical evidence of malignancy have also been reported and little information is available regarding surgery for metastatic ossifying fibromyxoid tumor. We present a case involving extensive excision of a huge metastatic ossifying fibromyxoid tumor occupying the upper mediastinum and upper half of the right hemithorax.