A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial

Appartient à l’ensemble documentaire : HNormand1Contient une table des matièresAvec mode text

A monitoring and feedback tool embedded in a counselling protocol to increase physical activity of patients with COPD or type 2 diabetes in primary care: study protocol of a three-arm cluster randomised controlled trial

BACKGROUND: Physical activity is important for a healthy lifestyle. Although physical activity can delay complications and decrease the burden of the disease, the level of activity of patients with chronic obstructive pulmonary disease (COPD) or type 2 Diabetes Mellitus (DM2) is often far from optimal. To stimulate physical activity, a monitoring and feedback tool, consisting of an accelerometer linked to a smart phone and webserver (It’s LiFe! tool), and a counselling protocol for practice nurses in primary care was developed (the Self-management Support Program). The main objective of this study is to measure the longitudinal effects of this counselling protocol and the added value of using the tool. METHODS/DESIGN: This three-armed cluster randomised controlled trial with 120 participants with COPD and 120 participants with DM2 (aged 40–70), compares the counselling protocol with and without the use of the tool (group 1 and 2) with usual care (group 3). Recruitment takes place at GP practices in the southern regions of the Netherlands. Randomisation takes place at the practice level. The intended sample (three arms of 8 practices) powers the study to detect a 10-minute difference of moderate and intense physical activity per day between groups 1 and 3. Participants in the intervention groups have to visit the practice nurse 3–4 times for physical activity counselling, in a 4-6-month period. Specific activity goals tailored to the individual patient's preferences and needs will be set. In addition, participants in group 1 will be instructed to use the tool in daily life. The primary outcome, physical activity, will be measured in all groups with a physical activity monitor (PAM). Secondary outcomes are quality of life, general - and exercise - self-efficacy, and health status. Follow-up will take place after 6 and 9 months. Separately, a process evaluation will be conducted to explore reasons for trial non-participation, and the intervention’s acceptability for participating patients and nurses. DISCUSSION: Results of this study will give insight into the effects of the It’s LiFe! monitoring and feedback tool combined with care from a practice nurse for people with COPD or DM2 on physical activity. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0186797

Usability testing of a monitoring and feedback tool to stimulate physical activity

Introduction: A monitoring and feedback tool to stimulate physical activity, consisting of an activity sensor, smartphone application (app), and website for patients and their practice nurses, has been developed: the 'It's LiFe!' tool. In this study the usability of the tool was evaluated by technology experts and end users (people with chronic obstructive pulmonary disease or type 2 diabetes, with ages from 40-70 years), to improve the user interfaces and content of the tool. Patients and methods: The study had four phases: 1) a heuristic evaluation with six technology experts; 2) a usability test in a laboratory by five patients; 3) a pilot in real life wherein 20 patients used the tool for 3 months; and 4) a final lab test by five patients. In both lab tests (phases 2 and 4) qualitative data were collected through a thinking-aloud procedure and video recordings, and quantitative data through questions about task complexity, text comprehensiveness, and readability. In addition, the post-study system usability questionnaire (PSSUQ) was completed for the app and the website. In the pilot test (phase 3), all patients were interviewed three times and the Software Usability Measurement Inventory (SUMI) was completed. Results: After each phase, improvements were made, mainly to the layout and text. The main improvement was a refresh button for active data synchronization between activity sensor, app, and server, implemented after connectivity problems in the pilot test. The mean score on the PSSUQ for the website improved from 5.6 (standard deviation [SD] 1.3) to 6.5 (SD 0.5), and for the app from 5.4 (SD 1.5) to 6.2 (SD 1.1). Satisfaction in the pilot was not very high according to the SUMI. Discussion: The use of laboratory versus real-life tests and expert-based versus user-based tests revealed a wide range of usability issues. The usability of the It's LiFe! tool improved considerably during the study

The preconditions for image care in disability care:A concept mapping study

Inleiding:Al jaren zijn er in Nederland verschillende initiatieven in de ambulante gehandicaptenzorg met beeldzorg. Echter, van brede implementatie is, ook na de Covid-19 pandemie, nog geen sprake. Mogelijk is er een andere manier van organiseren en implementeren nodig. Het doel van dit onderzoek was de randvoorwaarden in kaart te brengen voor kwalitatief goede beeldzorg voor mensen met een verstandelijke beperking, met behulp van de group concept mapping (GCM) methode. Onder beeldzorg wordt verstaan: zorg en ondersteuning op afstand tussen zorgverlener/begeleider en cliënt.MethodeEen diverse groep deelnemers deed mee aan de GCM procedure, die bestond uit het benoemen van randvoorwaarden in een online brainstorm, deze sorteren en waarderen en het interpreteren van de (door een onderzoekers geanalyseerde) resultaten.ResultatenDe concept map bestaat uit 99 opvattingen in 13 clusters. Genoemde randvoorwaarden gaan over de technologie én over beleid, intern in de organisatie en over wat er nodig is in relatie tot zorggebruikers, zijn/haar naasten, en andere organisaties.ConclusieDe concept map laat zien dat voor een duurzame implementatie van beeldzorg de verschillende randvoorwaarden gecombineerd moeten worden in zowel visie, beleid als uitvoering. Het gaat dan om onder andere applicaties, ICT-infrastructuur en ICT-ondersteuning, om training en scholing van zorgprofessionals, om de aansluiting van beeldzorg bij de behoeften, vragen en capaciteiten van cliënten met een verstandelijke beperking. Betrokkenheid van cliënten en zorgprofessionals daarbij is noodzakelijk

The preconditions for image care in disability care:A concept mapping study

Inleiding:Al jaren zijn er in Nederland verschillende initiatieven in de ambulante gehandicaptenzorg met beeldzorg. Echter, van brede implementatie is, ook na de Covid-19 pandemie, nog geen sprake. Mogelijk is er een andere manier van organiseren en implementeren nodig. Het doel van dit onderzoek was de randvoorwaarden in kaart te brengen voor kwalitatief goede beeldzorg voor mensen met een verstandelijke beperking, met behulp van de group concept mapping (GCM) methode. Onder beeldzorg wordt verstaan: zorg en ondersteuning op afstand tussen zorgverlener/begeleider en cliënt.MethodeEen diverse groep deelnemers deed mee aan de GCM procedure, die bestond uit het benoemen van randvoorwaarden in een online brainstorm, deze sorteren en waarderen en het interpreteren van de (door een onderzoekers geanalyseerde) resultaten.ResultatenDe concept map bestaat uit 99 opvattingen in 13 clusters. Genoemde randvoorwaarden gaan over de technologie én over beleid, intern in de organisatie en over wat er nodig is in relatie tot zorggebruikers, zijn/haar naasten, en andere organisaties.ConclusieDe concept map laat zien dat voor een duurzame implementatie van beeldzorg de verschillende randvoorwaarden gecombineerd moeten worden in zowel visie, beleid als uitvoering. Het gaat dan om onder andere applicaties, ICT-infrastructuur en ICT-ondersteuning, om training en scholing van zorgprofessionals, om de aansluiting van beeldzorg bij de behoeften, vragen en capaciteiten van cliënten met een verstandelijke beperking. Betrokkenheid van cliënten en zorgprofessionals daarbij is noodzakelijk

Structural basis for RNA polymerase II ubiquitylation and inactivation in transcription-coupled repair

During transcription-coupled DNA repair (TCR), RNA polymerase II (Pol II) transitions from a transcriptionally active state to an arrested state that allows for removal of DNA lesions. This transition requires site-specific ubiquitylation of Pol II by the CRL4CSA ubiquitin ligase, a process that is facilitated by ELOF1 in an unknown way. Using cryogenic electron microscopy, biochemical assays and cell biology approaches, we found that ELOF1 serves as an adaptor to stably position UVSSA and CRL4CSA on arrested Pol II, leading to ligase neddylation and activation of Pol II ubiquitylation. In the presence of ELOF1, a transcription factor IIS (TFIIS)-like element in UVSSA gets ordered and extends through the Pol II pore, thus preventing reactivation of Pol II by TFIIS. Our results provide the structural basis for Pol II ubiquitylation and inactivation in TCR.Genome Instability and CancerDermatology-oncolog

The cooperative action of CSB, CSA, and UVSSA target TFIIH to DNA damage-stalled RNA polymerase II

The response to DNA damage-stalled RNA polymerase II (RNAPIIo) involves the assembly of the transcription-coupled repair (TCR) complex on actively transcribed strands. The function of the TCR proteins CSB, CSA and UVSSA and the manner in which the core DNA repair complex, including transcription factor IIH (TFIIH), is recruited are largely unknown. Here, we define the assembly mechanism of the TCR complex in human isogenic knockout cells. We show that TCR is initiated by RNAPIIo-bound CSB, which recruits CSA through a newly identified CSA-interaction motif (CIM). Once recruited, CSA facilitates the association of UVSSA with stalled RNAPIIo. Importantly, we find that UVSSA is the key factor that recruits the TFIIH complex in a manner that is stimulated by CSB and CSA. Together these findings identify a sequential and highly cooperative assembly mechanism of TCR proteins and reveal the mechanism for TFIIH recruitment to DNA damage-stalled RNAPIIo to initiate repair. The response to DNA damage-stalled RNA polymerase II leads to the assembly of the transcription-coupled repair (TCR) complex on actively transcribed strands. Here, the authors reveal the complex assembly mechanism of the TCR complex in human cells.Genome Instability and Cance

TRiC controls transcription resumption after UV damage by regulating Cockayne syndrome protein A

Transcription-blocking DNA lesions are removed by transcription-coupled nucleotide excision repair (TC-NER) to preserve cell viability. TC-NER is triggered by the stalling of RNA polymerase II at DNA lesions, leading to the recruitment of TC-NER-specific factors such as the CSA-DDB1-CUL4A-RBX1 cullin-RING ubiquitin ligase complex (CRLCSA). Despite its vital role in TC-NER, little is known about the regulation of the CRLCSA complex during TC-NER. Using conventional and cross-linking immunoprecipitations coupled to mass spectrometry, we uncover a stable interaction between CSA and the TRiC chaperonin. TRiC's binding to CSA ensures its stability and DDB1-dependent assembly into the CRLCSA complex. Consequently, loss of TRiC leads to mislocalization and depletion of CSA, as well as impaired transcription recovery following UV damage, suggesting defects in TC-NER. Furthermore, Cockayne syndrome (CS)-causing mutations in CSA lead to increased TRiC binding and a failure to compose the CRLCSA complex. Thus, we uncover CSA as a TRiC substrate and reveal that TRiC regulates CSA-dependent TC-NER and the development of CS