Thierry Bury

Should we exclude elderly patients with chronic obstructive pulmonary disease from a long-time ambulatory pulmonary rehabilitation programme?

OBJECTIVEnTo assess the outcomes of a 6-month comprehensive multidisciplinary outpatient pulmonary rehabilitation programme in patients with chronic obstructive pulmonary disease according to age.nnnDESIGNnProspective cohort study.nnnPATIENTSnA total of 140 patients with chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 3-4) admitted to our centre for pulmonary rehabilitation.nnnMETHODSnPatients were divided into 3 groups: group A (<u200965 years), group B (65-74 years) and group C (≥u200975 years). All the patients received an education and individualized training programme. Pulmonary rehabilitation efficacy was evaluated at 6 months of treatment and 12 months post-treatment.nnnRESULTSnA total of 116 patients completed the pulmonary rehabilitation programme: 59 in group A (85.5%), 40 in group B (80%) and 17 in group C (80.9%). All the parameters studied (number of sessions, 6-min walking distance, isometric quadriceps strength, health-related quality of life, maximal load, peak oxygen uptake, maximal inspiratory and expiratory pressures) were significantly improved in each of the groups at 3 and 6 months compared with baseline. Moreover, percentage changes from baseline at 6 months for all of the parameters studied were not significantly different between age-groups.nnnCONCLUSIONnPulmonary rehabilitation is efficient in elderly patients with severe and very severe chronic obstructive pulmonary disease, and their compliance with pulmonary rehabilitation was similar to that seen in younger groups. Therefore, elderly patients with chronic obstructive pulmonary disease should not be denied pulmonary rehabilitation.

Multidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.

BACKGROUNDnDifferent clinical trials show beneficial effects of physical training offered during and/or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far.nnnAIMnThe aim of this study was to determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment.nnnDESIGNnControlled no-randomized trial.nnnSETTINGnUniversity for outcomes, University Hospital Center for interventions.nnnPOPULATIONnTwo hundred and nine outpatients who have been treated for a primary breast carcinoma.nnnMETHODSnPatients were divided into a control group (N.=106) and an experimental group (N.=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments (Sit and Reach Test, maximal incremental exercise test and Six-Minute Walk Test), body composition measurements (Body Mass Index [BMI] and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30).nnnRESULTSnAfter three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didnt appear and a significant increase in BMI and body fat percentage was observed.nnnCONCLUSIONSnThis trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment.nnnCLINICAL REHABILITATION IMPACTnThrough its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program.

A Comparison of 3D Methods for Identifying the Stance Phase in Treadmill Running for Both Rearfoot and Forefoot Runners

We compared six 3D methods, OptoGait, and Myotest Run for the determination of contact time for runners with different foot strike patterns. Twenty male participants were divided into two groups: the heel group, who attack the ground with the heel (n = 12), and the toe group, who attack the ground with the middle/front of the foot (n = 8). They performed trials at speeds of 8 km/h then 16 km/h. To detect foot strike, the use of peak velocity of 3D markers located on the heel, the fifth metatarsal, and the great toe provided the best results for both groups. To detect the toe off, the minimum vertical position of a 3D marker placed in line with the great toe gave the most satisfactory results for both groups. In this way, the values of contact time measured with the 3D methods are consistent. Values measured with OptoGait appear consistent too, while those of the Myotest Run underestimate the contact time for both speeds. 3D analysis provides interesting opportunities for calculation of contact time for both rearfoot and forefoot runners, using specific peak velocities to determine foot strike and marker displacement to determine toe off.

Influence of a multidisciplinary post-breast cancer rehabilitation program on lifestyle and behavior faced with physical activities

B the gaps in cancer care is a daunting task that requires self-awareness, education, and advocacy founded in the Code of Ethics for Nurses and aligned with our Nursing’s Social Policy Statement (ANA, 2010). Though ethical underpinnings of both the code and social contract with individuals, families, and communities remain constant, healthcare is constantly evolving. One of the most important roles of nurses as leaders in healthcare is to give voice to the under-served and ensure fairness and equity to all people regardless of race, creed, gender, or economic status (ANA, 2010). Now, with growing visibility of marginalized US populations, the healthcare industry and its providers are challenged to meet the needs of the LGBTQ populations in an equitable and just way. For several decades, grassroots efforts, championed by the Fenway Institute (Boston, MA) and many of our national medical and nursing organizations (IOM, ANA,), have called for an adjustments to the binary healthcare structure that has yet to address the new norms of an expanding diversity of culture. Inherent in the lack of readiness to support the LGBTQ community are deficits in provider information, ineffective communication, confusion surrounding gender and sexuality differences and conscious and unconscious biases that interfere with the ability to recognize and to deliver appropriate healthcare. Despite this trending need, pre-professional education has dedicated limited amount of time in preparing nurses, nurse practitioners and medical staff in the standards of care for LGBTQ people. For the purpose of this presentation, cancer risk assessment, screenings, healthcare practices, and health promotion for LGBTQ people, from the very young to the elderly, will be explored. Strategies to provide a compassionate, and welcoming environments to gender, non-conforming individuals will be discussed. Recommendations for nursing education and preparedness using evidence-based applications in clinical practice will be offered.Exercise stage b 3.152 Contemplation .281 1.208 0.054 1.325 (0.124-14.143) Preparation .851 1.282 0.441 2.342 (0.190-28.866) Action 1.291 1.298 0.989 3.636 (0.285-46.305) Maintenance 1.944 1.368 2.020 6.990 (0.478-102.125) Table1 the predictive factor analysis of glycemic control Introduction It is important for patients with diabetes mellitus to understand the importance of drug compliance and healthy lifestyle. However, the actual condition of this management is not ideal. The behavior of personality traits is an important factor of compliance. There is a close relationship between personality traits, self-discipline, and selfcare. It is critical to understand the personality traits of subjects for glycemic control. Methods This study was conducted in the Division of Metabolism in a teaching hospital in Taiwan. There were 219 patients with Type 2 diabetes under survey with questionnaires. The effective sample size is 214. Results a) The older the patients have the lower the risk of poor glycemic control. b) Increase of every 10 years of age, the risk of poor glycemic control decreases by 9.2%. c) Increased fasting blood glucose of 10mg/dl increases 59% risk of poor glycemic control. d) Increased every 10 g/dl TG makes the increase of risk for poor glycemic control by 39%. e) Patients with prudent personality or agreeable personality have a lower risk of poor glycemic control but without significant difference. f) Neuroticism personality is an important predictor for poor glycemic control g) Neuroticism personalities have a 7.52 times higher risk of poor glycemic control.

The cardiovascular impact of intense eccentric isokinetic exercise versus aerobic treadmill running

BACKGROUND: Regular physical activity is an important health factor, but intense physical stress can increase the risk of heart disease. OBJECTIVE:Our aim was to determine the potential cardiac repercussions of, and the oxidative stress resulting from a maximal eccentric isokinetic exercise and a 1-hour treadmill run at 75% ˙