International comparative study of low back pain care pathways and analysis of key interventions

Purpose Low back pain (LBP) is a major public health problem worldwide. Significant practice variation exists despite guidelines, including strong interventionist focus by some practitioners. Translation of guidelines into pathways as integrated treatment plans is a next step to improve implementation. The goal of the present study was to analyze international examples of LBP pathways in order to identify key interventions as building elements for care pathway for LBP and radicular pain. Methods International examples of LBP pathways were searched in literature and grey literature. Authors of pathways were invited to fill a questionnaire and to participate in an in-depth telephone interview. Pathways were quantitatively and qualitatively analyzed, to enable the identification of key interventions to serve as pathway building elements. Results Eleven international LBP care pathways were identified. Regional pathways were strongly organized and included significant training efforts for primary care providers and an intermediate level of caregivers in between general practitioners and hospital specialists. Hospital pathways had a focus on multidisciplinary collaboration and stepwise approach trajectories. Key elements common to all pathways included the consecutive screening for red flags, radicular pain and psychosocial risk factors, the emphasis on patient empowerment and self-management, the development of evidence-based consultable protocols, the focus on a multidisciplinary work mode and the monitoring of patient-reported outcome measures. Conclusion Essential building elements for the construction of LBP care pathways were identified from a transversal analysis of key interventions in a study of 11 international examples of LBP pathways

Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial

Background: Computer tailoring and motivational interviewing show promise in promoting lifestyle change, despite few head-to-head comparative studies. Purpose: Vitalum is a randomized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults. Methods: Participants (n?=?1,629) were recruited via 23 general practices and randomly received either four tailored print letters, four motivational telephone calls, two of each type of intervention, or no information. The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption. Results: All three intervention groups (i.e., the tailored letters, the motivational calls, and the combined version) were equally and significantly more effective than the control group in increasing physical activity (hours/day), intake of fruit (servings/day), and consumption of vegetables (grams/day) from baseline to the intermediate measurement (week 25), follow-up 1 (week 47) and 2 (week 73). Effect sizes (Cohen's d) ranged from 0.15 to 0.18. Participants rated the interventions positively; interviews were more positively evaluated than letters. Conclusions: Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors. © 2010 The Author(s)

Breeders’ opinions about mobile-slaughter of cattle in Flanders

Most meat-animals are confronted with the stresses of manipulation, transport and slaughter. Transport results in stress, increased potential for injuries, and for subsequent lower meat quality and quantity. The European legislation allows for national initiatives that investigate animal-friendly alternatives of live transport to the slaughter-house such as the development of a mobile slaughter unit. This could result in significant welfare amelioration by decreasing transport time and by eliminating transport-associated stressors such as loading and unloading, the shocks and sensory stimuli of driving, injuries, fatigue, waiting time, deprivation of water, inadequate micro-climate,…. We carried out several focus group-meetings to reveal the opinions on mobile slaughter among on-farm meat processing cattle breeders, cattle farmers and American bison breeders. The perceived benefits of mobile slaughter for the animals were: the low-stress, respectful, relaxed, familiar, quiet context for the animal, translating in higher meat quality. The farmers appreciate the possibility to follow up the treatment of the animal from birth till death, with a maximal transparency. They consider a respectful death of high importance. Parallel with the decreased animal-stress, the farmers expect to stress less themselves. On-farm mobile slaughter offers an attractive marketing story. Some breeders see a potential for on-farm education concerning slaughter. Most breeders trust that the consumers will be willing to pay a higher price; for some, the profitability is the biggest open question. Most on-farm marketers are confident that their current customers of conventionally slaughtered animals will continue to buy on-farm slaughtered meat. The practical concerns relate to the organization, timing, price, subsequent meat temperature and conservation, transport to the meat processing place and waste treatment. Most farmers think mobile slaughter is or will be feasible, some think it will practically not be feasible; most farmers “just want to do this”, they need political support and they want a dialogue with the food safety services. The majority of the breeders is positive towards the functioning of a mobile slaughter unit in Flanders.edition: Advancing animal welfare science: How do we get there? – Who is it good for?status: publishe

Het vormsel : godsdienstige en sociale functies

status: publishe

Hypoglycemia and decreased insulin requirement caused by malignant insulinoma in a type 1 diabetic patient: when the hoof beats are from a zebra, not a horse.

Insulinomas are uncommon tumors, and in patients with diabetes mellitus they are extremely rare. We describe a patient with type 1 diabetes who developed malignant insulinoma. When hypoglycemic episodes persist in a patient with diabetes and treatment‐induced and other causes of hypoglycemia have been ruled out, an insulin‐producing tumor should be considered

Total venous inflow occlusion and pericardial auto-graft reconstruction for right atrial hemangiosarcoma resection in a dog

A sizeable right atrial hemangiosarcoma in a 6-year-old Bordeaux dog, World Health Organization (WHO) stage 2, was excised using total venous inflow occlusion. The defect was restored with a non-vascularized pericardial auto-graft. The dog had a disease-free interval of 7 mo. The dog was euthanized 9 months later, at which time there were distant metastases but no indication of local recurrence

Upper limb function in children with unilateral cerebral palsy: a five-year follow-up study

Background and Objective(s) Development of upper limb function in children with unilateral cerebral palsy (CP) is often compromised by underlying motor and sensory impairments. However, knowledge about the long-term evolution of upper limb function in this population is scarce. The aims of this longitudinal study were to map the evolution of upper limb function over five years in children with unilateral CP and to identify factors that influence time trends. Study Design Longitudinal study Study Participants & Setting A consecutive sample of 81 children aged between 5 and 15 years were assessed at baseline, follow-up at 6 months (n=71), 1 year (n=73) and 5 years (n=68). Mean age at inclusion was 9y11mo (SD 3y3mo), 47% were female, 85% had congenital and 15% acquired lesions and participants covered Manual Ability Classification System (MACS) levels 1 (36%), level 2 (46%) and level 3 (18%). Materials/Methods Body function measurements included passive range of motion, muscle tone, manual muscle strength and grip strength. Activity measurements included the Melbourne Assessment (movement quality), the Jebsen Taylor test (manual dexterity) and the Assisting Hand Assessment (AHA, bimanual performance). Age, gender, etiology (congenital or acquired lesions) and MACS levels were analyzed as predictive factors, using mixed models. Results Between baseline and 5 years follow-up, a significant deterioration was noted for passive range of motion (p < 0. 001) and AHA scores (p < 0. 001), whereas a significant improvement was seen for grip strength (p < 0. 001), Melbourne Assessment (p=0. 003) and Jebsen Taylor test (p < 0. 001). Age had a significant influence on the time evolution of the passive range of motion (p < 0. 001), with children between 8 and 11 years old gaining more movement limitations over time. Age also significantly influenced the evolution of AHA scores (p=0. 003), with younger children being stable over time and from the age of 8 years old, children experienced a decrease in effective hand use in bimanual tasks. Gender, etiology and MACS levels significantly influenced the evolution of grip strength, which improved significantly more in boys (p < 0. 001), in children with congenital lesions (p < 0. 001) and in children with MACS level 1 (p < 0. 001). Finally, MACS levels also significantly impacted on the time evolution of AHA scores (p=0. 020), with children in MACS level 1 being stable in AHA scores compared to deterioration in AHA performance for children in MACS level 2 and 3. Conclusions/Significance Children with unilateral CP develop more limitations in passive range of motion in the upper limb over a 5-year time period. Although different capacity measures improve over time, the spontaneous use of the hemiplegic upper limb in bimanual tasks decreases over time and becomes less effective. These novel insights in the spontaneous evolution of upper limb function in children with unilateral CP can provide guidance in delineating treatment priorities.status: Published onlin