Effectiveness and cost-effectiveness of a blended exercise intervention for patients with hip and/or knee osteoarthritis:Study protocol of a randomized controlled trial

Background Exercise therapy in patients with hip and/or knee osteoarthritis is effective in reducing pain, increasing physical activity and physical functioning, but costly and a burden for the health care budget. A web-based intervention is cheap in comparison to face-to-face exercise therapy and has the advantage of supporting in home exercises because of the 24/7 accessibility. However, the lack of face-to-face contact with a professional is a disadvantage of web-based interventions and is probably one of the reasons for low adherence rates. In order to combine the best of two worlds, we have developed the intervention e-Exercise. In this blended intervention face-to-face contacts with a physical therapist are partially replaced by a web-based exercise intervention. The aim of this study is to investigate the short- (3 months) and long-term (12 months) (cost)-effectiveness of e-Exercise compared to usual care physical therapy. Our hypothesis is that e-Exercise is more effective and cost-effective in increasing physical functioning and physical activity compared to usual care. Methods/Design This paper presents the protocol of a prospective, single-blinded, multicenter cluster randomized controlled trial. In total, 200 patients with OA of the hip and/or knee will be randomly allocated into either e-Exercise or usual care (physical therapy). E-Exercise is a 12-week intervention, consisting of maximum five face-to-face physical therapy contacts supplemented with a web-based program. The web-based program contains assignments to gradually increase patients’ physical activity, strength and stability exercises and information about OA related topics. Primary outcomes are physical activity and physical functioning. Secondary outcomes are health related quality of life, self-perceived effect, pain, tiredness and self-efficacy. All measurements will be performed at baseline, 3 and 12 months after inclusion. Retrospective cost questionnaires will be sent at 3, 6, 9 and 12 months and used for the cost-effectiveness and cost-utility analysis. Discussion This study is the first randomized controlled trial in the (cost)-effectiveness of a blended exercise intervention for patients with osteoarthritis of the hip and/or knee. The findings will help to improve the treatment of patients with osteoarthritis. Keywords: Osteoarthritis, Physical activity, Blended care e-Healt

Electronic health record in dermatology service

In this paper we describe the implementation of an Electronic Health Record in the Dermatology service of a Portuguese hospital. This system must follow the principle of simplicity, enabling recording quality and analytical processing. Standards and norms were also followed and it is shown that interoperability has a key role in the whole process. This project is a good example of cooperation between academic and healthcare institutions and shows the impact of new technology on healthcare organizations.Fundação para a Ciência e a Tecnologia (FCT

HCI at the boundary of work and life

The idea behind this Special Issue originates in a workshop on HCI and CSCW research related to work and non-work-life balance organized in conjunction with the ECSCW 2013 conference by the issue co-editors. Fifteen papers were originally submitted for possible inclusion in this Special Issue, and four papers were finally accepted for publication after two rounds of rigorous peer review. The four accepted papers explore, in different ways, HCI at the boundary of work and life. In this editorial, we offer a description of the overall theme and rationale for the Special Issue, including an introduction on the topic relevance and background, and a reflection on how the four accepted papers further current research and debate on the topic

Exile Vol. XLIII No. 2

41st Year Title Page i Epigraphy by Ezra Pound ii Table of Contents iii / Contributors\u27 Notes 70-71 Editorial Board 72-73 ART Untitled by Kari Hernquist \u2799 4 Talking Out my Window by Heather Trabert \u2797 13 Renamed I by Ben Blake \u2797 18 photo paint by alex e. blazer \u2797 23 Butterfly by Mary Donnelley \u2797 32 unabridged by alex e. blazer \u2797 37 Holding Me In by Heather Trabert \u2797 43 Untitled by Kari Hernquist \u2797 55 Untitled by Camille Gammon-Hittelman \u2799 61 Stars by Mary Donnelley \u2797 69 POETRY Victrola by erin c. malone \u2799 1 All by Kellam Ayres \u2797 2-3 curtailed sun in the net by alex e. blazer \u2797 5 the weaker sex by Bekah Taylor \u2700 6 A poem concerning a silent manifesto by Colin Bossen \u2798 14 Father by Alison Stine \u2700 15 Vacant by Sean Boyle \u2700 16 Ecstasy by Amy spears \u2798 17 Seven Haikus by Jen Suster \u2797 21 Pages from a Diary by Trish Klei \u2797 22 Watching an Ageless Woman and an Ancient Trade by Heather Trabert \u2797 24-25 Still Waters by Jay Brandeis \u2799 26 just shy of freedom by Sean Boyle \u2700 36 [Touch the mothers you never knew] by Heather Trabert \u2797 38 Fishing for Meaning by Bekah Taylor \u2700 39 the novel by Sara Brown \u2799 40-41 annihilation by erin c. malone \u2799 42 Upon Enlistment by Trish Klei \u2797 44 the expatriate by erin c. malone \u2799 47 Rockettes by Trish Klei \u2797 48-49 Abstraction by Colin Bossen \u2798 54 always kinesis by alex e. blazer \u2797 56-57 Lily by Alison Stine \u2700 58-59 Falling In by Bekah Taylor \u2700 60 this bird has flown by paul durica \u2700 62-63 exfoliating some sun by alex e. blazer \u2797 64 Liberation: May 8, 1945 by Jen suster \u2797 65 PROSE Journal: 12 December 1996 through 15 January 1997 by Lynn Tramonte \u2798 7-12 Ash by paul durica \u2700 19-20 Birdhouse by Tyler Smith \u2797 27-35 Party in December by paul durica \u2700 45-46 Smoke Circles by Alison Stine \u2700 50-53 Seal by Lynn Tramonte \u2798 66-68 All submissions are reviewed on an anonymous basis, and all editorial decisions are shared equally among the members of the Editorial Board. -72 Cover art Toy Child by Ben Blake \u2797 -7

Methods to identify, study and understand End-user participation in HIT development

<p>Abstract</p> <p>Background</p> <p>Experience has shown that for new health-information-technology (HIT) to be suc-cessful clinicians must obtain <it>positive clinical benefits </it>as a result of its implementation and <it>joint-ownership </it>of the decisions made during the development process. A prerequisite for achieving both success criteria is <it>real </it>end-user-participation. Experience has also shown that further research into developing improved methods to collect more detailed information on social groups participating in HIT development is needed in order to support, facilitate and improve real end-user participation.</p> <p>Methods</p> <p>A case study of an EHR planning-process in a Danish county from October 2003 until April 2006 was conducted using process-analysis. Three social groups (physicians, IT-professionals and administrators) were identified and studied in the <it>local, present </it>perspective. In order to understand the interactions between the three groups, the <it>national, historic </it>perspective was included through a literature-study. Data were collected through observations, interviews, insight gathered from documents and relevant literature.</p> <p>Results</p> <p>In the local, present perspective, the administrator's strategy for the EHR planning process meant that there was no clinical workload-reduction. This was seen as one of the main barriers to the physicians to achieving real influence. In the national, historic perspective, physicians and administrators have had/have different perceptions of the purpose of the patient record and they have both struggled to influence this definition. To date, the administrators have won the battle. This explains the conditions made available for the physicians' participation in this case, which led to their role being reduced to that of clinical consultants - rather than real participants.</p> <p>Conclusion</p> <p>In HIT-development the interests of and the balance of power between the different social groups involved are decisive in determining whether or not the end-users become real participants in the development process. Real end-user-participation is essential for the successful outcome of the process. By combining and developing existing theories and methods, this paper presents an improved method to collect more detailed information on social groups participating in HIT-development and their interaction during the development. This allows HIT management to explore new avenues during the HIT development process in order to support, facilitate and improve real end-user participation.</p

The photometric evolution of FU Orionis objects: disc instability and wind-envelope interaction

We present the results of a photometric monitoring campaign of three well studied FU Orionis systems (FU Orionis, V1057 Cygni and V1515 Cygni) undertaken at Maidanak Observatory between 1981 and 2003. When combined with photometric data in the literature, this database provides a valuable resource for searching for short timescale variability - both periodic and aperiodic - as well as for studying the secular evolution of these systems. In the case of V1057 Cyg (which is the system exhibiting the largest changes in brightness since it went into outburst) we compare the photometric data with time dependent models. We show that prior to the end of the `plateau' stage in 1996, the evolution of V1057 Cyg in the $V-(B-V)$ colour-magnitude diagram is well represented by disc instability models in which the outburst is triggered by some agent - such as an orbiting planet - in the inner disc. Following the end of the plateau phase in 1996, the dimming and irregular variations are consistent with occultation of the source by a variable dust screen, which has previously been interpreted in terms of dust condensation events in the observed disc wind. Here we instead suggest that this effect results from the interaction between the wind and an infalling dusty envelope, the existence of this envelope having been previously invoked in order to explain the mid infrared emissio of FU Orionis systems. We discuss how this model may explain some of the photometric and spectroscopic characteristics of FU Orionis systems in general.Comment: 14 pages, 12 figures, MNRAS, accepted. Data files with detailed photometry can be found at http://www.ast.cam.ac.uk/~giuseppe/Publications