Synergizing expectation and execution for stroke communities of practice innovations

<p>Abstract</p> <p>Background</p> <p>Regional networks have been recognized as an interesting model to support interdisciplinary and inter-organizational interactions that lead to meaningful care improvements. Existing communities of practice within the a regional network, the Montreal Stroke Network (MSN) offers a compelling structure to better manage the exponential growth of knowledge and to support care providers to better manage the complex cases they must deal with in their practices. This research project proposes to examine internal and external factors that influence individual and organisational readiness to adopt national stroke best practices and to assess the impact of an e-collaborative platform in facilitating knowledge translation activities.</p> <p>Methods</p> <p>We will develop an e-collaborative platform that will include various social networking and collaborative tools. We propose to create online brainstorming sessions ('jams') around each best practice recommendation. Jam postings will be analysed to identify emergent themes. Syntheses of these analyses will be provided to members to help them identify priority areas for practice change. Discussions will be moderated by clinical leaders, whose role will be to accelerate crystallizing of ideas around 'how to' implement selected best practices. All clinicians (~200) involved in stroke care among the MSN will be asked to participate. Activities during face-to-face meetings and on the e-collaborative platform will be documented. Content analysis of all activities will be performed using an observation grid that will use as outcome indicators key elements of communities of practice and of the knowledge creation cycle developed by Nonaka. Semi-structured interviews will be conducted among users of the e-collaborative platform to collect information on variables of the knowledge-to-action framework. All participants will be asked to complete three questionnaires: the typology questionnaire, which classifies individuals into one of four mutually exclusive categories of information seeking; the e-health state of readiness, which covers ten domains of the readiness to change; and a community of practice evaluation survey.</p> <p>Summary</p> <p>This project is expected to enhance our understanding of collaborative work across disciplines and organisations in accelerating implementation of best practices along the continuum of care, and how e-technologies influence access, sharing, creation, and application of knowledge.</p

Retombées métalliques sur les sols de la région Fos-Berre (Sud de la France) : Approche magnétique et géochimique appliquée à la discrimination des sources démission

L'enjeu de ce travail est de déterminer, pour la région de Fos - Berre, les relations entre particules magnétiques et éléments chimiques en vue de tester les limites d'application d'une approche indirecte de mesure de la contamination de l'environnement en métaux lourds par le magnétisme. les zones d'investigation sont l'usine sidérurgique Sollac Fos, la cimenterie Lafarge-Fos el la plaine de la Crau. Des échantillons de nature, variée (aérosols, sols, eaux, poussières sidérurgiques) sont soumis à des mesures magnétiques et chimiques. Pour comprendre des points particuliers liés à la signature des sources et aux phases minérales porteuses de certains métaux, l'isotopic du Pb et du Sr, ainsi que la spectroscopie EXAFS ont été mises en œuvre...AIX-MARSEILLE3-BU Sc.St Jérô (130552102) / SudocSudocFranceF

Spondylarthrite ankylosante (étiologie, données génétiques récentes et perspectives thérapeutiques)

La spondylarthrite ankylosante (SA) est une maladie rhumatismale inflammatoire chronique dont l'étiologie est mal connue. Cette maladie complexe affecte les articulations sacro-iliaques et le rachis ainsi que les conditions de vie avec des conséquences socio-économiques. La pathogenèse n'est pas complètement connue et son diagnostic est difficile. L'aspect génétique de la SA est évident lorsque l'on considère les antécédents familiaux de la maladie et la forte association avec le gène HLA-B27. Le management et le traitement sont souvent non satisfaisants pour le patient. Ce mémoire décrit cette maladie, son impact sur la santé et résume les différentes stratégies de traitements ainsi que leurs développements futurs. Aujourd'hui, les anti-inflammatoires non stéroïdiens traitent les symptômes inflammatoires et sont des traitements de première intention souvent en association avec des analgésiques classique. Cependant, leur toxicité limite leur utilisation. En seconde intention, on utilise des corticostéroïdes, le méthotréxate, la sulfasalazine et les biophosphonates. Les thérapies biologiques concernant les anti-TNF a (Remicad®, Enbrel® et Humira®) améliorent favorablement le processus inflammatoire mais leurs effets indésirables sont importants. Les thérapies émergentes concernent les nouvelles molécules immunomodulatrices (non anti-TNF a) comme l'antagoniste de l'IL1 humain, qui est couramment utilisé pour traiter la polyarthrite rhumatoïde.AMIENS-BU Santé (800212102) / SudocSudocFranceF

Séance d’ouverture

Photo 1 – Le Professeur Alain Cotta lors de la conférence d’ouverture.� À gauche, le Président Ernest Gibert. Photo 2 – Le Professeur Michel Maffesoli s’apprête à donner sa conférence. Photo 3 – Le Professeur Marcel Rufo s’exprimant lors de la table ronde de l’USE. Photo 4 – Les jeunes du « stage com » témoignent. En arrière-plan, Yann Hildwein, journaliste à L’Équipe, et Roger Pureur, Faculté des Sports de l’Université Lille 2. Accueil d’Hélène de LA ROCHETTE,Secrétaire du CREPS d’Aix-en-..

Bibliothèque virtuelle Henri Labrouste : la bibliothèque Sainte-Geneviève et son architecte

International audienceEdition numérique en TEI du Journal manuscrit des travaux de construction de la Bibliothèque Sainte-Geneviève tenu par son architecte Henri Labrouste de 1843 à 1851, conservé à la BSG sous la cote BSG ms 3910. Avec les images du manuscrit et des notices sur les personnes et les lieux.En ligne : https://bvhl.bsg.univ-paris3.fr

Somatic gain-of-function HIF2A mutations in sporadic central nervous system hemangioblastomas

International audienceCentral nervous system hemangioblastomas (CNS-HBs) occur sporadically or as a component of von Hippel-Lindau-VHL syndrome. CNS-HBs share some molecular similarities with pheochromocytomas/paragangliomas (PPGLs) and renal cell carcinomas (RCCs). Recently, hypoxia-inducible factors, particularly somatic HIF2A mutations, have been found to play an important role in the pathogenesis of PPGLs. Somatic mutations in HIF2A have been reported in PPGLs associated with polycythemia, which have been reported to also be present in patients with RCCs and HBs. However, whether CNS-HBs is associated with the presence of a HIF2A mutation is currently uknown. We analyzed somatic HIF2A and VHL mutations in a series of 28 sporadic CNS-HBs. We also investigated the expression of HIF target proteins and hypoxia-associated factor (HAF). Two sporadic CNS-HBs were found to have somatic HIF2A mutations. One tumor had 2 HIF2A missense mutations, one of which was previously described in a PPGL (c.1121 T\textgreaterA, F374Y). The second patient had coexistence of somatic truncated mutations (c.1669 C\textgreaterT, Q557*) in HIF2A together with a VHL mutation. Neither of the two patients had polycythemia at the time of diagnosis. We demonstrate that the novel truncated mutation in HIF2A (Q557*) affects HIF-2α prolyl hydroxylation with its reduced ubiquitination but intact transcriptional activity, resulting in an activating effect. Both CNS-HB samples showed positive expression of VEGFR2/CA9/Glut1 and HAF. Our data support the unique central role of the VHL/HIF-2α signaling pathway in the molecular pathogenesis of CNS-HBs and show for the first time the presence of HIF2A mutations in sporadic HB

Effects of Telerehabilitation on Patient Adherence to a Rehabilitation Plan: Protocol for a Mixed Methods Trial

BackgroundStrong evidence supports beginning stroke rehabilitation as soon as the patient’s medical status has stabilized and continuing following discharge from acute care. However, adherence to rehabilitation treatments over the rehabilitation phase has been shown to be suboptimal. ObjectiveThe aim of this study is to assess the impact of a telerehabilitation platform on stroke patients’ adherence to a rehabilitation plan and on their level of reintegration into normal social activities, in comparison with usual care. The primary outcome is patient adherence to stroke rehabilitation (up to 12 weeks), which is hypothesized to influence reintegration into normal living. Secondary outcomes for patients include functional recovery and independence, depression, adverse events related to telerehabilitation, use of services (up to 6 months), perception of interprofessional shared decision making, and quality of services received. Interprofessional collaboration as well as quality of interprofessional shared decision making will be measured with clinicians. MethodsIn this interrupted time series with a convergent qualitative component, rehabilitation teams will be trained to develop rehabilitation treatment plans that engage the patient and family, while taking advantage of a telerehabilitation platform to deliver the treatment. The intervention will be comprised of 220 patients who will take part in stroke telerehabilitation with an interdisciplinary group of clinicians (telerehabilitation group) versus face-to-face standard of care (control group: n=110 patients). ResultsOur Research Ethics Board approved the study in June 2020. Data collection for the control group is underway, with another year planned before we begin the intervention phase. ConclusionsThis study will contribute to the minimization of both knowledge and practice gaps, while producing robust, in-depth data on the factors related to the effectiveness of telerehabilitation in a stroke rehabilitation continuum. Findings will inform best practice guidelines regarding telecare services and the provision of telerehabilitation, including recommendations for effective interdisciplinary collaboration regarding stroke rehabilitation. Trial RegistrationClinicalTrials.gov NCT04440215; https://clinicaltrials.gov/ct2/show/NCT04440215 International Registered Report Identifier (IRRID)DERR1-10.2196/3213