Are Improvements Maintained After In-home Pulmonary Telerehabilitation for Patients with Chronic Obstructive Pulmonary Disease?

This study investigated if improvements can be maintained over 24 weeks when in-home pulmonary telerehabilitation is combined with asynchronous self-management education for Chronic Obstructive Pulmonary Disease (COPD). Twenty-three community-living elders with moderate to very severe COPD participated in a pre/post-intervention study. Over 8 weeks, they had access to self-learning capsules on self-management, received 15 in-home teletreatment sessions and were encouraged to gradually engage in unsupervised sessions. Participants were assessed before the intervention (T1), immediately after the intervention (T2), and 6 months later (T3). Outcome measures were 1) exercise tolerance (6-minute walk test [6MWT]), Cycle Endurance Test [CET]), and 2) quality of life (Chronic Respiratory Questionnaire [CRQ]). Although there were significant improvements after 8 weeks of pulmonary telerehabilitation on the 6MWT, CET and three of four CRQ domains, none of these improvements were maintained after 6 months and scores returned to their baseline values (all p values > 0.05 when comparing T3 with T1).  While pulmonary telerehabilitation is possible and has a positive impact on patients with moderate to very severe COPD, improvements were not maintained in the long-term even when physical therapy was accompanied by self-management education.

Energy and position resolution of a CdZnTe gamma-ray detector with orthogonal coplanar anodes

We report on the simulation, construction and performance of prototype CZT imaging detectors employing orthogonal coplanar anodes. These detectors employ a novel electrode geometry with non-collecting anode strips in 1D and collecting anode pixels, interconnected in rows, in the orthogonal dimensions. These detectors retain the spectroscopic and detection efficiency advantages of single carried charge sensing devices as well as the principal advantage of conventional strip detectors with orthogonal anode and cathode strips, i.e. an N X N array of imagin pixels are realized with only 2N electronic channels. Charge signals induced on the various electrodes of a prototype detector with 8 X 8 unit cells are in good agreement with the simulations. The position resolution is about 1 mm in the direction perpendicular to the pixel lines while it is of the order of 100 micrometers in the other direction. Energy resolutions of 0.9 percent at 662 keV, 2.6 percent at 122 keV and 5.7 percent at 60 keV have been obtained at room temperature

The traces of World War I in Brussels

The hundredth anniversary of World War I has put the spotlight on this period once again. The media coverage of the commemorations is unprecedented and even surprising for a conflict which has remained in the memorial shadow of the even more deadly World War II. While there was every reason to believe that the Great War was only a distant memory, it must also be noted that it is still the object of true curiosity on the part of the general public. The hundredth anniversary has also led to a number of publications, most of which are in keeping with the revival of historical research surrounding World War I for the past twenty years or so. The case of Belgium – the scene of fighting in a territory which was almost completely occupied – has thus been well studied. However, while several recent studies have used Brussels as a framework, a global summary specifically devoted to the capital does not exist. This synopsis thus summarises the material traces and immaterial heritage of the conflict in Brussels. The aim is therefore not to trace the history of Brussels during World War I or to present the latest works on this subject, but rather to answer some simple questions asked by the inhabitants of Brussels today: What remains of World War I in the capital? Who is interested in it, and why? How does this conflict resonate today in Brussels’ memories? How are they reflected in the urban space? In other words, this synopsis reverses the historical temporality to observe the results of the sifting of time.Le centenaire de la Première Guerre mondiale a remis cette période sous les feux des projecteurs. Le retentissement médiatique des premières commémorations a été tout à fait inédit, voire surprenant, pour un conflit longtemps resté dans l’ombre d’une Seconde Guerre mondiale plus meurtrière encore. Si tout portait à croire que la Grande Guerre n’était plus qu’un lointain souvenir, force est de constater qu’elle fait encore l’objet d’une réelle curiosité de la part du grand public. Ce centenaire a aussi engendré une multitude de publications dont beaucoup s’inscrivent dans le renouveau des recherches historiques sur la Première Guerre mondiale en cours depuis une grosse vingtaine d’années. Le cas de la Belgique, théâtre de combats et territoire presque totalement occupé, a été abondamment étudié. Par contre si une série de travaux récents ont pris Bruxelles pour cadre d’analyse, une synthèse globale spécifiquement consacrée à la capitale fait encore défaut. Cette première note synthétise donc les traces matérielles et les héritages immatériels du conflit à Bruxelles. L’ambition n’est dès lors pas de retracer l’histoire de Bruxelles pendant la Première Guerre mondiale, ni même de présenter les derniers travaux sur ce sujet mais de répondre à quelques questions simples que se posent aujourd’hui les Bruxellois : que reste-t-il de la Première Guerre mondiale dans la capitale ? Qui s’y intéresse et pourquoi ? Quelles résonances ce conflit a-t-il encore aujourd’hui dans les mémoires bruxelloises ? Comment se répercutent-elles dans l’espace urbain ? En d’autres mots, cette note prend le parti de renverser la temporalité historique pour observer le résultat opéré par le tri du temps.De honderdste verjaardag van de Eerste Wereldoorlog heeft die periode weer voor het voetlicht gebracht. De belangstelling van de media voor de eerste herdenkingen is ongezien en zelfs verrassend voor een conflict dat lange tijd in de schaduw van de nog moorddadigere Tweede Wereldoorlog is gebleven. Alles wees erop dat de “Groote Oorlog” niet meer dan een verre herinnering was, maar we moeten vaststellen dat het grote publiek er echt meer over wil weten. Ter gelegenheid van de honderdste verjaardag zijn er ook veel werken gepubliceerd, waarvan een groot aantal aansluit bij de hernieuwde belangstelling van de laatste twintig jaar voor historisch onderzoek over de Eerste Wereldoorlog. Het geval België, waar strijd werd geleverd en waarvan het grondgebied bijna volledig bezet was, is zeer uitgebreid bestudeerd. Verschillende recente studies gaan over Brussel, maar er ontbreekt nog een allesomvattende synthese die specifiek aan de hoofdstad is gewijd. Deze eerste nota geeft dus een overzicht van de materiele en immateriële sporen van het conflict in Brussel. De synthesenota heeft niet de bedoeling om de geschiedenis van Brussel tijdens de Eerste Wereldoorlog te beschrijven noch de recentste werken over dat onderwerp te presenteren, maar om antwoorden te geven op enkele eenvoudige vragen die de Brusselaars zich vandaag stellen: wat blijft er over van de Eerste Wereldoorlog in Brussel? Wie interesseert zich daarvoor? Waarom? Welke plaats neemt het conflict vandaag nog in het Brusselse geheugen in? Hoe komt dat tot uiting in de stedelijke ruimte? Met andere woorden, de nota gaat omgekeerd chronologisch te werk en gaat na wat de tand des tijds heeft doorstaan

In de sporen van de Eerste Wereldoorlog in Brussel

De honderdste verjaardag van de Eerste Wereldoorlog heeft die periode weer voor het voetlicht gebracht. De belangstelling van de media voor de eerste herdenkingen is ongezien en zelfs verrassend voor een conflict dat lange tijd in de schaduw van de nog moorddadigere Tweede Wereldoorlog is gebleven. Alles wees erop dat de “Groote Oorlog” niet meer dan een verre herinnering was, maar we moeten vaststellen dat het grote publiek er echt meer over wil weten. Ter gelegenheid van de honderdste verjaardag zijn er ook veel werken gepubliceerd, waarvan een groot aantal aansluit bij de hernieuwde belangstelling van de laatste twintig jaar voor historisch onderzoek over de Eerste Wereldoorlog. Het geval België, waar strijd werd geleverd en waarvan het grondgebied bijna volledig bezet was, is zeer uitgebreid bestudeerd. Verschillende recente studies gaan over Brussel, maar er ontbreekt nog een allesomvattende synthese die specifiek aan de hoofdstad is gewijd. Deze eerste nota geeft dus een overzicht van de materiele en immateriële sporen van het conflict in Brussel. De synthesenota heeft niet de bedoeling om de geschiedenis van Brussel tijdens de Eerste Wereldoorlog te beschrijven noch de recentste werken over dat onderwerp te presenteren, maar om antwoorden te geven op enkele eenvoudige vragen die de Brusselaars zich vandaag stellen: wat blijft er over van de Eerste Wereldoorlog in Brussel? Wie interesseert zich daarvoor? Waarom? Welke plaats neemt het conflict vandaag nog in het Brusselse geheugen in? Hoe komt dat tot uiting in de stedelijke ruimte? Met andere woorden, de nota gaat omgekeerd chronologisch te werk en gaat na wat de tand des tijds heeft doorstaan.Le centenaire de la Première Guerre mondiale a remis cette période sous les feux des projecteurs. Le retentissement médiatique des premières commémorations a été tout à fait inédit, voire surprenant, pour un conflit longtemps resté dans l’ombre d’une Seconde Guerre mondiale plus meurtrière encore. Si tout portait à croire que la Grande Guerre n’était plus qu’un lointain souvenir, force est de constater qu’elle fait encore l’objet d’une réelle curiosité de la part du grand public. Ce centenaire a aussi engendré une multitude de publications dont beaucoup s’inscrivent dans le renouveau des recherches historiques sur la Première Guerre mondiale en cours depuis une grosse vingtaine d’années. Le cas de la Belgique, théâtre de combats et territoire presque totalement occupé, a été abondamment étudié. Par contre si une série de travaux récents ont pris Bruxelles pour cadre d’analyse, une synthèse globale spécifiquement consacrée à la capitale fait encore défaut. Cette première note synthétise donc les traces matérielles et les héritages immatériels du conflit à Bruxelles. L’ambition n’est dès lors pas de retracer l’histoire de Bruxelles pendant la Première Guerre mondiale, ni même de présenter les derniers travaux sur ce sujet mais de répondre à quelques questions simples que se posent aujourd’hui les Bruxellois : que reste-t-il de la Première Guerre mondiale dans la capitale ? Qui s’y intéresse et pourquoi ? Quelles résonances ce conflit a-t-il encore aujourd’hui dans les mémoires bruxelloises ? Comment se répercutent-elles dans l’espace urbain ? En d’autres mots, cette note prend le parti de renverser la temporalité historique pour observer le résultat opéré par le tri du temps.The hundredth anniversary of World War I has put the spotlight on this period once again. The media coverage of the commemorations is unprecedented and even surprising for a conflict which has remained in the memorial shadow of the even more deadly World War II. While there was every reason to believe that the Great War was only a distant memory, it must also be noted that it is still the object of true curiosity on the part of the general public. The hundredth anniversary has also led to a number of publications, most of which are in keeping with the revival of historical research surrounding World War I for the past twenty years or so. The case of Belgium – the scene of fighting in a territory which was almost completely occupied – has thus been well studied. However, while several recent studies have used Brussels as a framework, a global summary specifically devoted to the capital does not exist. This synopsis thus summarises the material traces and immaterial heritage of the conflict in Brussels. The aim is therefore not to trace the history of Brussels during World War I or to present the latest works on this subject, but rather to answer some simple questions asked by the inhabitants of Brussels today: What remains of World War I in the capital? Who is interested in it, and why? How does this conflict resonate today in Brussels’ memories? How are they reflected in the urban space? In other words, this synopsis reverses the historical temporality to observe the results of the sifting of time

An interdisciplinary guideline development process: the Clinic on Low-back pain in Interdisciplinary Practice (CLIP) low-back pain guidelines

<p>Abstract</p> <p>Background</p> <p>Evaluation of low-back pain guidelines using Appraisal of Guidelines Research and Evaluation (AGREE) criteria has shown weaknesses, particularly in stakeholder involvement and applicability of recommendations. The objectives of this project were to: 1) develop a primary care interdisciplinary clinical practice guideline aimed at preventing prolonged disability from low-back pain, using a community of practice approach, and 2) assess the participants' impressions with the process, and evaluate the relationship between participant characteristics and their participation.</p> <p>Methods</p> <p>Ten stakeholder representatives recruited 136 clinicians to participate in this community of practice. Clinicians were drawn from the following professions: physiotherapists (46%), occupational therapists (37%), and family physicians (17%). Using previously published guidelines, systematic reviews, and meta-analyses, a first draft of the guidelines was presented to the community of practice. Four communication tools were provided for discussion and exchanges with experts: a web-based discussion forum, an anonymous comment form, meetings, and a symposium. Participants were prompted for comments on interpretation, clarity, and applicability of the recommendations. Clinical management recommendations were revised following these exchanges. At the end of the project, a questionnaire was sent to the participants to assess satisfaction towards the guidelines and the development process.</p> <p>Results</p> <p>Twelve clinical management recommendations on management of low-back pain and persistent disability were initially developed. These were discussed through 188 comments posted on the discussion forum and 103 commentary forms submitted. All recommendations were modified following input of the participants. A clinical algorithm summarizing the guidelines was also developed. A response rate of 75% was obtained for the satisfaction questionnaire. The majority of respondents appreciated the development process and agreed with the guideline content. Most participants thought recommendations improved between versions, and that participant comments contributed to this improvement. All stakeholders officially endorsed the guidelines.</p> <p>Conclusion</p> <p>The community of practice approach was a successful method to develop guidelines on low-back pain, with participants providing information to improve guideline recommendations. The information technology infrastructure that was developed remains for continuous interdisciplinary exchanges and updating of the guidelines.</p

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting

BACKGROUND: Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. METHODS: The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. RESULTS AND DISCUSSION: Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. CONCLUSION: The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere

Evaluation of the implementation of an integrated primary care network for prevention and management of cardiometabolic risk in Montréal

<p>Abstract</p> <p>Background</p> <p>The goal of this project is to evaluate the implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk (PCMR). The intervention is based on the Chronic Care Model. The study will evaluate the implementation of the PCMR in 6 of the 12 health and social services centres (CSSS) in Montréal, and the effects of the PCMR on patients and the practice of their primary care physicians up to 40 months following implementation, as well as the sustainability of the program. Objectives are: 1-to evaluate the effects of the PCMR and their persistence on patients registered in the program and the practice of their primary care physicians, by implementation site and degree of exposure to the program; 2-to assess the degree of implementation of PCMR in each CSSS territory and identify related contextual factors; 3-to establish the relationships between the effects observed, the degree of PCMR implementation and the related contextual factors; 4-to assess the impact of the PCMR on strengthening local services networks.</p> <p>Methods/Design</p> <p>The evaluation will use a mixed design that includes two complementary research strategies. The first strategy is similar to a quasi-experimental "before-after" design, based on a quantitative approach; it will look at the program's effects and their variations among the six territories. The effects analysis will use data from a clinical database and from questionnaires completed by participating patients and physicians. Over 3000 patients will be recruited. The second strategy corresponds to a multiple case study approach, where each of the six CSSS constitutes a case. With this strategy, qualitative methods will set out the context of implementation using data from semi-structured interviews with program managers. The quantitative data will be analyzed using linear or multilevel models complemented with an interpretive approach to qualitative data analysis.</p> <p>Discussion</p> <p>Our study will identify contextual factors associated with the effectiveness, successful implementation and sustainability of such a program. The contextual information will enable us to extrapolate our results to other contexts with similar conditions.</p> <p>Trial registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01326130">NCT01326130</a></p