Minimal versus specialist equipment for the delivery of pulmonary rehabilitation in COPD

Background: Evidence for pulmonary rehabilitation(PR)largely comes from trials where the intervention used specialist aerobic and/or resistance equipment.Limited data exist to demonstrate the efficacy of PR in community settings with minimal equipment. Aims: To compare completion rates and outcomes in COPD patients undergoing PR in a community setting with minimal equipment(PR-min)with a matched sample undergoing PR in a gym setting with specialist aerobic and resistance equipment(PR-gym). Methods: Using propensity score matching,318 patients with COPD referred for 8 weeks of PR-min were matched 1:1 with a control group of 318 patients who undertook 8 weeks of PR-gym. Completion rate(attendance≥8 supervised sessions)and changes in incremental shuttle walk(ISW),Chronic Respiratory Disease Questionnaire(CRQ)and quadriceps maximal voluntary contraction(QMVC)were compared. Results: Groups were matched for age(70.8v70.7years),FEV1%predicted(46.8v45.8),ISW(192v195m),%current smoking status(19v20)and depression scores(6.5v6.6).No between group differences were seen in ISW,CRQ or QMVC change. Completion rates were better in the PR-gym(73%)as opposed to the PR-min(64%);p=0.01. Conclusion: This case-control study shows that PR-min had similar benefits to PR-gym.A randomised non-inferiority trial is needed to confirm the findings of this study

Physical frailty and pulmonary rehabilitation in COPD: a prospective cohort study

BACKGROUND: Frailty is an important clinical syndrome that is consistently associated with adverse outcomes in older people. The relevance of frailty to chronic respiratory disease and its management is unknown. OBJECTIVES: To determine the prevalence of frailty among patients with stable COPD and examine whether frailty affects completion and outcomes of pulmonary rehabilitation. METHODS: 816 outpatients with COPD (mean (SD) age 70 (10) years, FEV1% predicted 48.9 (21.0)) were recruited between November 2011 and January 2015. Frailty was assessed using the Fried criteria (weight loss, exhaustion, low physical activity, slowness and weakness) before and after pulmonary rehabilitation. Predictors of programme non-completion were identified using multivariate logistic regression, and outcomes were compared using analysis of covariance, adjusting for age and sex. RESULTS: 209/816 patients (25.6%, 95% CI 22.7 to 28.7) were frail. Prevalence of frailty increased with age, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage, Medical Research Council (MRC) score and age-adjusted comorbidity burden (all p≤0.01). Patients who were frail had double the odds of programme non-completion (adjusted OR 2.20, 95% CI 1.39 to 3.46, p=0.001), often due to exacerbation and/or hospital admission. However, rehabilitation outcomes favoured frail completers, with consistently better responses in MRC score, exercise performance, physical activity level and health status (all p<0.001). After rehabilitation, 71/115 (61.3%) previously frail patients no longer met case criteria for frailty. CONCLUSIONS: Frailty affects one in four patients with COPD referred for pulmonary rehabilitation and is an independent predictor of programme non-completion. However, patients who are frail respond favourably to rehabilitation and their frailty can be reversed in the short term

Kinematics of an Anatomically Designed Cruciate-Retaining Total Knee Arthroplasty Implanted Using a Spacer-Guided PCL Balancing Technique

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DEVELOPMENT AND VALIDATION OF A FINITE ELEMENT MODEL TO PREDICT PATELLO-FEMORAL WEAR IN TKA

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J Can Acad Child Adolesc Psychiatry

Objective: Anxiety-based school refusal in adolescence is a complex, sometimes difficult to treat disorder that can have serious academic and psychiatric consequences. The objective of this qualitative study was to explore how teens with this problem and their parents experience the psychiatric care received. Methods: This qualitative multicenter study took place in France, where we conducted semi-structured interviews with adolescents receiving psychiatric care for anxiety-based school refusal and with their parents. Data collection by purposive sampling continued until we reached theoretical sufficiency. Data analysis was thematic. Results: This study included 20 adolescents aged 12 to 18 years and 21 parents. Two themes emerged from the analysis: (1) the goals of psychiatric care with two sub-themes, "self-transformation" and problem solving; and, (2) the therapeutic levers identified as effective with two sub-themes: time and space and relationships. Conclusion: Our results show a divergence between parents and teens in their representations of care and especially of its goals. Therapeutic and research implications about the terms of return to school within psychiatric care and also the temporality of care are discussed

Accuracy of Femoral Component Alignment Using Specimen Matched Cutting Blocks: An in Vitro Study

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Autour de Lanfranc (1010-2010)

Le colloque a saisi l’opportunité de la célébration du millénaire de la naissance de Lanfranc (1010-1089), grand prélat réformateur originaire d’Italie du Nord, prieur du Bec et abbé de Saint-Étienne de Caen, en Normandie, puis archevêque de Cantorbéry, en Angleterre, pour mener à bien une réflexion d’histoire comparée sur la réforme ecclésiastique dans l’Europe du Nord-Ouest aux XIe et XIIe siècles. Centré sur le monde anglo-normand – l’horizon de Lanfranc – tout en s’ouvrant à d’autres espaces, comme la Scandinavie et la Russie, la rencontre a éclairé la notion discutée de « réforme », dans ses conceptions, ses usages, sa diffusion, sa réception et ses particularismes locaux, et a replacé l’action réformatrice au centre des pratiques sociales, imaginaires et concrètes, du haut clergé et du populus christianus

Can CT-based patient-matched instrumentation achieve consistent rotational alignment in knee arthroplasty?

Long-term success of contemporary total knee replacements relies to a large extent on proper implant alignment. This study was undertaken to test whether specimen-matched cutting blocks based on computed axial tomography (CT) scans could provide accurate rotational alignment of the femoral component.Journal Articleinfo:eu-repo/semantics/publishe