Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework

Question: From the perspective of intensive care unit (ICU) clinicians, what are the barriers to and facilitators of implementing early mobilisation? Design: A qualitative study using focus groups, with analysis using the Theoretical Domains Framework. Participants: Physicians, nurses, respiratory therapists and physiotherapists from the ICUs of three university-affiliated hospitals in Montreal, Canada. Methods: Four focus group meetings were conducted with 33 participating ICU clinicians. Two researchers independently performed thematic content analysis on verbatim transcriptions of the audio recordings using the Theoretical Domains Framework. Results: Data saturation was reached after the third focus group. Thirty-six barriers were categorised in 13 domains of the Theoretical Domains Framework. The key barriers to early mobilisation were: lack of conviction and knowledge regarding the available evidence about early mobilisation; lack of attention to the provision of optimal care; poor communication; the unpredictable nature of the ICU; and limited staffing, equipment, time and clinical knowledge. Twenty-five facilitators categorised in ten TDF domains were also identified. These included individual-level facilitators (intrinsic motivation, positive outcome expectations, conscious effort to mobilise early, good planning/coordination, the presence of ICU champions, and expert support by a physiotherapist) and organisational-level facilitators (reminder system, pro-early mobilisation culture, implementation of an early mobilisation protocol, and improved ICU organisation). Conclusions: A broad array of barriers to and facilitators of early mobilisation in the ICU were identified in this study. Clinicians can consider whether these barriers and facilitators are operating in their ICU. These may inform the design of tailored knowledge translation interventions to promote early mobilisation in the ICU

Professional barriers and facilitators to using stratified care approaches for managing non-specific low back pain: a qualitative study with Canadian physiotherapists and chiropractors

Background: Recent clinical practice guidelines for the management of non-specific low back pain (LBP) recommend using stratified care approaches. To date, no study has assessed barriers and facilitators for health professionals in using stratified care approaches for managing non-specific LBP in the Canadian primary care setting. This study aimed to identify and contrast barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors. Methods: Individual telephone interviews, underpinned by the Theoretical Domains Framework (TDF), explored beliefs and attitudes about, and identified barriers and facilitators to the use of stratified care approaches for managing non-specific LBP in a purposive sample of 13 chiropractors and 14 physiotherapists between September 2015 and June 2016. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using directed content analysis. Results: Three and seven TDF domains were identified as likely relevant for physiotherapists and chiropractors, respectively. Shared key beliefs (and relevant domains of the TDF) for both physiotherapists and chiropractors included: lack of time, cost, and expertise (Environmental Context and Resources); and consulting more experienced colleagues and chronic patients with important psychological overlay (Social Influences). Unique key domains were identified among physiotherapists: incompatibility with achieving other objectives (Goals), and chiropractors: confidence in using stratified care approaches (Beliefs about Capabilities); intention to use stratified care approaches (Intentions); awareness and agreement with stratified care approaches (Knowledge); assessment of readiness for change and intentional planning behaviour (Behavioural Regulation); and improving the management of non-specific LBP patients and the uptake of evidence-based practice (Beliefs about Consequences). Conclusions: Several shared and unique barriers and facilitators to using the stratified care approaches for non-specific LBP among Canadian physiotherapists and chiropractors were identified. Findings may help inform the design of tailored theory-based knowledge translation interventions to increase the uptake of stratified care approaches in clinical practice. © The Author(s). 2019

Temporal multimode storage of entangled photon pairs

Multiplexed quantum memories capable of storing and processing entangled photons are essential for the development of quantum networks. In this context, we demonstrate the simultaneous storage and retrieval of two entangled photons inside a solid-state quantum memory and measure a temporal multimode capacity of ten modes. This is achieved by producing two polarization entangled pairs from parametric down conversion and mapping one photon of each pair onto a rare-earth-ion doped (REID) crystal using the atomic frequency comb (AFC) protocol. We develop a concept of indirect entanglement witnesses, which can be used as Schmidt number witness, and we use it to experimentally certify the presence of more than one entangled pair retrieved from the quantum memory. Our work puts forward REID-AFC as a platform compatible with temporal multiplexing of several entangled photon pairs along with a new entanglement certification method useful for the characterisation of multiplexed quantum memories

Selecting and training opinion leaders and best practice collaborators: experience from the Canadian Chiropractic Guideline Initiative

Objectives: To describe the process for selecting and training chiropractic opinion leaders (OLs) and best practice collaborators (BPCs) to increase the uptake of best practice. Methods: In Phase 1, OLs were identified using a cross-sectional survey among Canadian chiropractic stakeholders. A 10-member committee ranked nominees. Top-ranked nominees were invited to a training workshop. In Phase 2, a national e-survey was administered to 7200 Canadian chiropractors to identify additional OLs and BPCs. Recommended names were screened by OLs and final selection made by consensus. Webinars were utilized to train BPCs to engage peers in best practices, and facilitate guideline dissemination. Results: In Phase 1, 21 OLs were selected from 80 nominees. Sixteen attended a training workshop. In Phase 2, 486 chiropractors recommended 1126 potential BPCs, of which 133 were invited to participate and 112 accepted. Conclusions: OLs and BPCs were identified across Canada to enhance the uptake of research among chiropractors. (English) [ABSTRACT FROM AUTHOR] Objectifs : Décrire le processus permettant de choisir et former les leaders d'opinion (LO) et collaborateurs des pratiques d'exemplaire (CPE) en chiropratique dans le but de favoriser l'adoption des pratiques d'excellence. Méthodologie : Lors de la première phase, on a désigné les LO au moyen d'une enquête transversale parmi les intervenants canadiens de la chiropratique. Un comité composé de dix membres a classé les candidats. Les candidats les mieux classés ont été invités à un atelier de formation. Lors de la deuxième phase, 7 200 chiropraticiens canadiens se sont soumis à une enquête nationale en ligne visant à désigner d'autres LO et CPE. Les noms recommandés ont été présélectionnés par les LO et le choix final s'est fait d'un commun accord. On s'est servi de webinaires pour former les LO à encourager leurs pairs à adopter des pratiques d'excellence et faciliter la diffusion des lignes directrices. Résultats : Lors de la première phase, on a choisi 21 LO parmi 80 candidats. Seize d'entre eux ont assisté à un atelier de formation. Lors de la deuxième phase, 486 chiropraticiens ont recommandé 1 126 LO potentiels, parmi lesquels 133 ont été invités à participer et 112 ont accepté. Conclusions : On a désigné des LO et CPE à l'échelle du pays pour favoriser l'adoption de la recherche parmi les chiropraticiens. (French) [ABSTRACT FROM AUTHOR] Copyright of Journal of the Canadian Chiropractic Association is the property of Canadian Chiropractic Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract

Ionizing radiation exposure -- more good than harm? The preponderance of evidence does not support abandoning current standards and regulations

The article responds to a commentary by P.A. Oakley and colleagues on "phantom risks" associated with diagnostic ionizing radiation. It examines the evidence in support of revising radiography standards and regulations in chiropractic. The article claims that Oakley and his colleagues provide a biased and unscientific evaluation of the evidence

Letters to the Editor

A letter to the editor is presented in response to the article "A Rebuttal to Chiropractic Radiologists' View of the 50 year old, Linear-No-Threshold Radiation Risk Model" in the previous issue

High-efficiency WSi superconducting nanowire single-photon detectors operating at 2.5 K

We investigate the operation of WSi superconducting nanowire single-photon detectors (SNSPDs) at 2.5 K, a temperature which is ~ 70 % of the superconducting transition temperature (TC) of 3.4 K. We demonstrate saturation of the system detection efficiency at 78 +- 2 % with a jitter of 191 ps. We find that the jitter at 2.5 K is limited by the noise of the readout, and can be improved through the use of cryogenic amplifiers. Operation of SNSPDs with high efficiency at temperatures very close to TC appears to be a unique property of amorphous WSi