Implementation of clinical guidelines on physical therapy for patients with low back pain: randomized trial comparing patient outcomes after a standard and active implementation strategy

Contains fulltext : 47628.pdf (publisher's version ) (Closed access)BACKGROUND AND PURPOSE: An active strategy was developed for the implementation of the clinical guidelines on physical therapy for patients with low back pain. The effect of this strategy on patients' physical functioning, coping strategy, and beliefs regarding their low back pain was studied. SUBJECTS: One hundred thirteen primary care physical therapists treated a total of 500 patients. METHODS: The physical therapists were randomly assigned to 1 of 2 groups. The control group received the guidelines by mail (standard passive method of dissemination). The intervention group, in contrast, received an additional active training strategy consisting of 2 sessions with education, group discussion, role playing, feedback, and reminders. Patients with low back pain, treated by the participating therapists, completed questionnaires on physical functioning, pain, sick leave, coping, and beliefs. RESULTS: Physical functioning and pain in the 2 groups improved substantially in the first 12 weeks. Multilevel longitudinal analysis showed no differences between the 2 groups on any outcome measure during follow-up. DISCUSSION AND CONCLUSION: The authors found no additional benefit to applying an active strategy to implement the physical therapy guidelines for patients with low back pain. Active implementation strategies are not recommended if patient outcomes are to be improved

Quantum dots for multimodal molecular imaging of angiogenesis

Quantum dots exhibit unique optical properties for bioimaging purposes. We have previously developed quantum dots with a paramagnetic and functionalized coating and have shown their potential for molecular imaging purposes. In the current mini-review we summarize the synthesis procedure, the in vitro testing and, importantly, the in vivo application for multimodal molecular imaging of tumor angiogenesis

Финансовое обеспечение деятельности туристического предприятия

Целью статьи является разработка рекомендаций по повышению эффективности финансового обеспечения деятельности туристического предприятия, определение приоритетных путей совершенствования финансовых показателей его деятельности

Effectiviteit van een actieve implementatiestrategie van de KNGF-richtlijn 'lage-rugpijn'

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Modeling the His-Purkinje Effect in Non-invasive Estimation of Endocardial and Epicardial Ventricular Activation

Inverse electrocardiography (iECG) estimates epi- and endocardial electrical activity from body surface potentials maps (BSPM). In individuals at risk for cardiomyopathy, non-invasive estimation of normal ventricular activation may provide valuable information to aid risk stratification to prevent sudden cardiac death. However, multiple simultaneous activation wavefronts initiated by the His-Purkinje system, severely complicate iECG. To improve the estimation of normal ventricular activation, the iECG method should accurately mimic the effect of the His-Purkinje system, which is not taken into account in the previously published multi-focal iECG. Therefore, we introduce the novel multi-wave iECG method and report on its performance. Multi-wave iECG and multi-focal iECG were tested in four patients undergoing invasive electro-anatomical mapping during normal ventricular activation. In each subject, 67-electrode BSPM were recorded and used as input for both iECG methods. The iECG and invasive local activation timing (LAT) maps were compared. Median epicardial inter-map correlation coefficient (CC) between invasive LAT maps and estimated multi-wave iECG versus multi-focal iECG was 0.61 versus 0.31. Endocardial inter-map CC was 0.54 respectively 0.22. Modeling the His-Purkinje system resulted in a physiologically realistic and robust non-invasive estimation of normal ventricular activation, which might enable the early detection of cardiac disease during normal sinus rhythm

Influence of head models on neuromagnetic fields and inverse source localizations

BACKGROUND: The magnetoencephalograms (MEGs) are mainly due to the source currents. However, there is a significant contribution to MEGs from the volume currents. The structure of the anatomical surfaces, e.g., gray and white matter, could severely influence the flow of volume currents in a head model. This, in turn, will also influence the MEGs and the inverse source localizations. This was examined in detail with three different human head models. METHODS: Three finite element head models constructed from segmented MR images of an adult male subject were used for this study. These models were: (1) Model 1: full model with eleven tissues that included detailed structure of the scalp, hard and soft skull bone, CSF, gray and white matter and other prominent tissues, (2) the Model 2 was derived from the Model 1 in which the conductivity of gray matter was set equal to the white matter, i.e., a ten tissuetype model, (3) the Model 3 consisted of scalp, hard skull bone, CSF, gray and white matter, i.e., a five tissue-type model. The lead fields and MEGs due to dipolar sources in the motor cortex were computed for all three models. The dipolar sources were oriented normal to the cortical surface and had a dipole moment of 100 μA meter. The inverse source localizations were performed with an exhaustive search pattern in the motor cortex area. A set of 100 trial inverse runs was made covering the 3 cm cube motor cortex area in a random fashion. The Model 1 was used as a reference model. RESULTS: The reference model (Model 1), as expected, performed best in localizing the sources in the motor cortex area. The Model 3 performed the worst. The mean source localization errors (MLEs) of the Model 3 were larger than the Model 1 or 2. The contour plots of the magnetic fields on top of the head were also different for all three models. The magnetic fields due to source currents were larger in magnitude as compared to the magnetic fields of volume currents. DISCUSSION: These results indicate that the complexity of head models strongly influences the MEGs and the inverse source localizations. A more complex head model performs better in inverse source localizations as compared to a model with lesser tissue surfaces

Maintenance of HSC by Wnt5a secreting AGM-derived stromal cell line

The microenvironment wherein hematopoietic stem cells (HSC) reside orchestrates HSC self-renewal vs. differentiation decisions. Stromal cells derived from ontogenically divergent hematopoietic microenvironments can support HSC in vitro and have been used to decipher factors that influence HSC fate decisions. Employing stromal cell lines derived from the aorta-gonad-mesonephros and embryonic liver, we aim to identify secreted factors that maintain/expand HSC in vitro.status: publishe