Radial shockwave therapy for a painful bone spur in an above-knee amputee

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Attitudes envers les benzodiazépines et intentions de sevrage des personnes âgées de 50 ans et plus

L’objectif de cette étude qualitative est de mettre en parallèle les attitudes envers les benzodiazépines (Bz) et les intentions de sevrage de personnes âgées de 50 ans et plus, utilisatrices à long terme dans le but de contrer des symptômes d’anxiété et d’insomnie. À cet effet, 23 utilisateurs (14 femmes et neuf hommes) ont été rencontrés lors d’entretiens en profondeur. Les analyses ont fait ressortir trois styles de consommateurs, soit : le style « sans-souci », le style « réaliste » et le style « pragmatique ». Les consommateurs du premier groupe n’ont pas de réticence à utiliser la substance qui est, selon eux, un médicament prescrit à bon escient. Les consommateurs du deuxième groupe estiment que la substance est une drogue dangereuse et certains vont même, avec beaucoup d’inconfort, tenter de cesser toute consommation par eux-mêmes, sans supervision médicale. Pour le dernier groupe, la Bz est considérée comme mi-drogue, mi-médicament, avec ses dangers mais également ses avantages. La motivation d’entamer un sevrage ou de réduire la consommation varie grandement d’une personne à l’autre. Les deux derniers groupes de consommateurs étaient les plus ouverts à un changement de comportement. Les attitudes envers la molécule, tantôt vue comme un médicament, tantôt comme une drogue, ou bien les deux, doivent être prises en compte dans une intervention de sevrage. Trois cas cliniques illustrent les résultats.The objective of this qualitative study was to contrast attitudes towards benzodiazepine (Bz) use stemming from long-term users, aged 50 and up, with their intent to undergo a weaning process. Use aimed at counteracting symptoms of anxiety and insomnia. Twenty-three users (14 women and 9 men) underwent in-depth interviews. Analyses brought-out three types of users that is, the “carefree” style; the “realist” style; the “pragmatic” style. The first group had no qualms with regard to the substance. To their eyes, it was a wisely prescribed medication. For the second group, the substance represented a dangerous drug. Some tried, at their own risk to stop usage without medical supervision. For the last group, the Bz is perceived as half-drug, half-medication, with its own dangers and advantages. All respondents are drug users; however motivation to engage in a weaning process or at least to reduce usage varied greatly, the last two groups being the most open to behavioural change. Attitudes towards the substance, which alternate between medication and drugs, or a combination of both, must be taken into account in an intervention program. Three clinical portraits illustrate these results.Este estudio cualitativo se propone hacer un paralelo entre las actitudes con las benzodiazepinas y las intenciones de desadicción en personas de más de 50 años que las utilizan a largo plazo para contrarrestar los síntomas de la ansiedad y el insomnio. Con este fin, se llevaron a cabo entrevistas en profundidad con veintitrés usuarios (catorce mujeres y nueve hombres). El análisis ha revelado tres tipos de usuarios: el estilo “despreocupado”, el estilo “realista” y el estilo “pragmático”. Los consumidores del primer grupo no se mostraron reticentes a utilizar la sustancia, que consideran como un medicamento prescripto oportunamente. Los consumidores del segundo grupo estiman que la sustancia es una droga peligrosa y algunos incluso llegan a tratar de interrumpir el consumo por su propia cuenta, sufriendo mucha incomodidad y sin supervisión médica. Para el último grupo, la benzodiazepina está considerada como una sustancia que es mitad droga, mitad medicamento, con sus peligros pero también con sus ventajas. La motivación para comenzar un proceso de desadicción o reducir el consumo varía mucho de una persona a la otra. Los dos últimos grupos de consumidores eran los más abiertos a un cambio de comportamiento. Las actitudes con respecto a la molécula, a veces vista como una droga, a veces como un medicamento, o bien las dos cosas, deben tenerse en cuenta en una intervención de desadicción. Tres casos clínicos ilustran los resultados

Use of an innovative model to evaluate mobility in seniors with lower-limb amputations of vascular origin: a pilot study

<p>Abstract</p> <p>Background</p> <p>The mobility of older individuals has often been only partially assessed, without considering all important aspects such as potential (available) versus effective (used) mobilities and the physical and psychosocial factors that modulate them. This study proposes a new model for evaluating mobility that considers all important aspects, applied here to lower-limb amputees with vascular origin. This model integrates the concepts of potential mobility (e.g. balance, speed of movement), effective mobility (e.g. life habits, movements in living areas) and factors that modulate these two types of mobility (e.g. strength, sensitivity, social support, depression). The main objective was to characterize potential and effective mobility as well as mobility modulators in a small sample of people with lower-limb amputations of vascular origin with different characteristics. The second objective of this pilot study was to assess the feasibility of measuring all variables in the model in a residential context.</p> <p>Methods</p> <p>An observational and transversal design was used with a heterogeneous sample of 10 participants with a lower-limb amputation of vascular origin, aged 51 to 83, assessed between eight and 18 months after discharge from an acute care hospital. A questionnaire of participant characteristics and 16 reliable and valid measurements were used.</p> <p>Results</p> <p>The results show that the potential mobility indicators do not accurately predict effective mobility, i.e., participants who perform well on traditional measures done in the laboratory or clinic are not always those who perform well in the real world. The model generated 4 different profiles (categories) of participants ranging from reduced to excellent potential mobility and low to excellent effective mobility, and characterized the modulating factors. The evaluations were acceptable in terms of the time taken (three hours) and the overall measurements, with a few exceptions, which were modified to optimize the data collected and the classification of the participants. For the population assessed, the results showed that some of the negative modulators (particularly living alone, no rehabilitation, pain, limited social support, poor muscle strength) played an important role in reducing effective mobility.</p> <p>Conclusion</p> <p>The first use of the model revealed interesting data that add to our understanding of important aspects linked to potential and effective mobility as well as modulators. The feasibility of measuring all variables in the model in a residential context was demonstrated. A study with a large number of participants is now warranted to rigorously characterize mobility levels of lower-limb amputees with vascular origin.</p