Personalized Massive Open Online Course for Childhood Cancer Survivors: Behind the Scenes

Background  Today, in France, it is estimated that 1 in 850 people aged between 20 and 45 years has been treated for childhood cancer, which equals 40,000 to 50,000 people. As late effects of the cancer and its treatment affect a large number of childhood cancer survivors (CCS) and only 30% of them benefit from an efficient long-term follow-up care for prevention, early detection, and treatment of late effects, health education of CCS represents a challenge of public health. Objectives  Massive open online courses (MOOCs) are a recent innovative addition to the online learning landscape. This entertaining and practical tool could easily allow a deployment at a national level and make reliable information available for all the CCS in the country, wherever they live. Methods  The MOOC team brings together a large range of specialists involved in the long-term follow-up care, but also associations of CCS, video producers, a communication consultant, a pedagogical designer, a cartoonist and a musician. We have designed three modules addressing transversal issues (lifestyle, importance of psychological support, risks of fertility problems) and eight modules covering organ-specific problems. Detailed data on childhood cancer treatments received were used to allocate the specific modules to each participant. Results  This paper presents the design of the MOOC entitled “Childhood Cancer, Living Well, After,” and how its feasibility and its impact on CCS knowledge will be measured. The MOOC about long-term follow-up after childhood cancer, divided into 11 modules, involved 130 participants in its process, and resulted in a 170-minute film. The feasibility study included 98 CCS (31 males vs. 67 females; p  < 0.0001). Conclusion  Such personalized, free, and online courses with an online forum and a possible psychologist consultation based on unique characteristics and needs of each survivor population could improve adherence to long-term follow-up without alarming them unnecessarily.     

ICU患者双上肢握力及髋关节屈曲拉力水平及其影响因素

目的调查ICU患者双上肢握力及髋关节屈曲拉力及其主要影响因素。 方法选取2019年4月至7月青海省人民医院77例ICU患者为研究对象,男性55例,女性22例,平均年龄（56.09±18.44）岁。收集患者一般病例资料（包括一般社会学资料,入住ICU后,出ICU前及出ICU时评价指标）,测量其在入住ICU时和出ICU时双上肢握力及髋关节屈曲拉力。 结果患者入住ICU时及出ICU时,上肢握力分别为（22.14±10.91）kg、（23.22±12.01）kg,差异有统计学意义（t=2.490,P=0.015）;髋关节屈曲拉力分别为（9.99±6.23）kg、（11.14±7.87）kg,差异有统计学意义（t=4.605,P＜0.001）。患者出ICU时,ADL评分较入住ICU时有显著改善,差异有统计学意义（Z=4.401,P＜0.001）,患者营养不良比例、红细胞、血红蛋白较入住ICU时有显著性下降,差异有统计学意义（χ²=65.07,t=5.208,t=2.688,P＜0.05）,其余化验指标均无显著性改变（P＞0.05）。患者上肢握力与年龄（r=-0.540）、性别（r=-0.415）、婚姻状况（r=-0.512）、住ICU天数（r=-0.304）、机械通气天数（r=-0.246）、人工气道天数呈显著性负相关（r=-0.224）,与ADL评分（r=0.316）呈显著正相关;髋关节屈曲拉力与性别（r=-0.452）、营养状态（r=-0.334）呈显著负相关。 结论ICU患者上肢握力及髋关节屈曲拉力呈现较低水平,随着疾病恢复逐渐增强。对于高龄、女性、有吸烟史、有饮酒史及已婚的患者在住ICU期间要更加关注其肌肉健康状态,患者住ICU期间要根据病情尽早拔除人工气道、缩短机械通气的时间,同时要加强患者的营养,为预防ICU患者肌肉衰减做好预防工作。     

三维超声监测肛提肌裂孔形态改变动态评估女性产后盆底器官脱垂的研究

目的:研究分析三维超声监测肛提肌裂孔形态改变动态评估女性产后盆底器官脱垂的价值。方法:选取2019年6月—2020年10月在我院诊治的40例肛提肌裂孔形态改变研究对象作为此次研究组研究对象,收集40例同一时期的未孕女性为参照组。同时给予两组研究对象三维超声监测,分析三维超声监测在,女性提肌裂孔形态改变动态评估女性产后盆底器官脱垂的价值。结果:在三维超声监测下,可以知道在不同状态下研究组的肛提肌裂孔面积均大于参照组,组间差异有统计学意义(P<0.05);在不同状态下研究组的产后盆底器官脱垂情况对比,研究组与参照组研究对象的静息下直肠壶腹部组间没有明显差异,其自身不存在统计学意义(P>0.05),除此之外的静息下子宫颈、静息下膀胱、瓦氏动作下直肠壶腹部、瓦氏动作下子宫颈以及瓦氏动作下膀胱的两组研究对象的位置存在很大的差异,经过统计学软件分析可以得到其自身组间差异有统计学意义(P<0.05)。结论:肛提肌裂孔形态改变研究对象经过三维超声监测,可以动态评估自身存在产后的盆地器官脱落情况,得到肛提肌裂孔的形态、大小以及变化趋势,实现疾病的良好预测。     

Surgical treatment of advanced medication-related osteonecrosis of the jaws: Comparison of soft tissue closure techniques and evaluation of side effects

The aim of the study was to evaluate the surgical outcome of patients with advanced medication-related osteonecrosis of the jaw (MRONJ) treated with different flaps for soft tissue closure. Only MRONJ stage III patients with a minimum follow-up of 6 months were included in our prospective study. The soft tissue closure techniques were: Mylohyoid Muscle Flap, Buccal Fat Flap and mucoperiosteal flap alone. Potential risk factors and surgical side effects were analyzed. Relapses occurred in 12 of 44 included cases and 38 reached mucosal integrity within the follow-up. Cases treated with the muscle or fat flap showed better results regarding the recurrence rate (p < 0.001) and soft tissue healing (p = 0.002): only 3 of 33 developed a relapse, and 31 of 33 reached mucosal integrity. The outcome was worse if MRONJ occurred at the front areas of the jaw (p = 0.025). Postoperative, the pain level was reduced significantly (p < 0.001). Partial hypoesthesia of the lip arose in 18 cases. An impairment of the long-term prosthetic rehabilitation has not been seen.Patients with MRONJ stage III undergoing surgery benefit from extensive soft tissue closure.     

Validity of a portable hanging scale to assess the isometric muscle strength during knee movement

Inexpensive and practical equipment to assess muscle strength can disseminate objective measures, which can provide valid information to implement effective treatment and exercise training. The purpose of the study was to examine the instrumental validity of the hanging scale (HS) to assess the muscle strength during knee flexion and extension by comparing the peak force values to a standard equipment (laboratory-grade load cell [LLC]). Knee isometric strength was assessed on thirty-two subjects (16 women and 16 men, 22 [5] years, 171 [9] cm, 69 [15] kg, 23 [4] kg/m²). The knee flexion was tested by placing the volunteer's body in prone with the knee flexed at 90°. Knee extension was assessed with the volunteer seated on a chair with the feet resting on the floor, knees, and hips flexed at 90°. No differences were observed comparing the isometric peak forces between a laboratory-grade load cell and a HS (p > 0.05). The intraclass correlation coefficient (ICC)_1,1 returned values above 0.90. The Cronbach's α test also returned values above 0.90 for all comparisons. Bland-Altman results showed high levels of agreement with low risk of bias. The HS appears to be a valid method to assess the knee isometric strength. The portability, the cost-effectiveness and the simple user-friendly system provides an effective way to assess the knee isometric strength.     

Using a single dose of photobiomodulation (laser + LED) to improve performance of lower limbs in functional test: Randomized clinical trial

BackgroundPhotobiomodulation (PBM) improves motor performance despite doubts whether it occurs immediately or late after a single dose. We evaluated the effect of a cluster PMB (laser + LED) single dose on muscle fatigue recovery in young sedentary adults, both immediately and in the short term (period between 24 and 48 h) after the fatiguing event.MethodsRandomized clinical trial with 60 volunteers randomized in 5 groups (n = 12 in each): control/(CG); placebo/(SG); PBM in knee extensor/(KE_G); plantar-flexor/(PF_G); knee extensor + plantar-flexor/(KE + FP_G). Before the intervention (pre) a fatiguing event (FE) was applied, which consisted in going up and down one step until exhaustion. Repetition number (RN) and time to exhaustion (TTE) were recorded. Then each group received its respective intervention and immediately after that, the FE was performed again (immediate post). In the period between 24 and 48 h after irradiation, a new FE was performed (late post). In addition to the comparative statistics, complementary metrics (if the mean difference [Diff] between the comparison pairs was higher or lower than minimum detectable change [MDC] and effect size [ES]) were calculated.ResultsThrough the integrated analysis of inferential statistics and complementary metrics, it was observed that although there was no time of evaluation effect, there was a group effect. PBM improved performance in KE + FP_G (p-value<0.05; Diff>MDC; ES = moderate) and PF_G (p-value>0.05; but Diff > MDC; ES = moderate) regarding CG for both RN and TTE.ConclusionA PBM single dose irradiation may improve motor performance and there is specificity of the irradiated muscle group, although it does not depend on the moment.     

个体化健康教育方案对高龄不孕症患者辅助生殖技术中自我管理的影响

目的：探讨个体化健康教育方案对高龄不孕症患者辅助生殖技术中自我管理的影响。方法：选取2018年1月—2020年12月在我科就诊的高龄不孕症患者200例,按随机数字表分为观察组(n=100)和对照组(n=100)。观察组采用个体化健康教育方案,对照组采用常规健康教育。观察并统计分析干预前和干预12周周期自我管理能力中遵医嘱治疗、定期检查、合理饮食、坚持运动及依从性5项评分、自我效能评定量表评分、医学应对问卷面对、回避、屈服评分及焦虑和抑郁负性情绪评分。结果 干预12周后,2组周期自我管理能力遵医嘱治疗、定期检查、合理饮食、坚持运动及依从性5项评分高于干预前(P＜0.05); 且观察组5项评分均高于对照组(P＜0.05)。干预后,2组自我对照效能评定量表评分干预前(P＜0.05),且观察组评分高于对照组(P＜0.05)。干预后,2组医学应对问卷各项维度评分中面对项评分明显高于干预前(P＜0.05),回避、放弃项评分明显低于干预前(P＜0.05),且观察组评分更优于对照组(P＜0.05)。干预后,2组SAS、SDS评分明显低于干预前(P＜0.05),且观察组评分低于对照组(P＜0.05)。结论：采用个体化健康教育方案后可提高对高龄不孕症患者对生殖技术的基本正确,提高自我管理意识和自我效能,从而改善负性情绪,利于高龄不孕症提高妊娠率。     

国际辅助技术服务的政策架构、核心内容和发展研究

目的 研究联合国和世界卫生组织(WHO)辅助技术服务的政策架构与核心内容,比较不同经济发展水平国家辅助技术发展现状,探讨未来辅助技术政策与服务发展。方法 基于联合国和WHO辅助技术的相关政策与理论架构,运用WHO健康服务体系构成要素的理论,分析国际辅助技术服务的政策架构与主要内容,比较全球不同经济发展水平国家辅助技术服务政策、辅助产品和服务发展,探讨国际辅助技术的政策与创新技术发展热点。结果 辅助技术服务是康复服务的重要组成部分,发展辅助技术服务是实现联合国可持续发展目标三“确保健康的生活方式,促进各年龄段人群的福祉”的关键步骤。联合国和WHO发布的辅助技术服务相关指南提供了辅助技术服务政策,其核心架构是基于联合国《残疾人权利公约》有关辅助技术内容,并具体表现在WHO《世界残疾报告》《全球残疾行动计划》《健康服务体系中的康复》和《健康服务体系中的康复：行动指南》以及WHA 71.8号有关辅助技术的决议《改善获得辅助技术的机会》等核心文件中。国际辅助技术政策核心内容旨在构建以人为本的综合保健服务,强调将辅助技术纳入公共卫生医疗体系和康复服务范畴,根据WHO健康服务的六大核心构成要素建立和发展辅助技术服务,从而提高获取优质辅助技术机会,以实现全民健康覆盖,并且在辅助产品和辅助技术服务领域,倡导技术和服务创新,形成5P辅助技术模式。高收入国家和中低收入国家在辅助技术服务政策、辅助技术产品提供以及服务覆盖率方面都面临诸多困难,存在着较大差异。未来各国辅助技术发展热点主要是采用WHO提出的5P模式进行政策和服务提供以及技术变革,辅助技术产品开发、辅助技术服务模式的创新将是未来发展的热点。结论 国际社会有关辅助技术的政策是以联合国《残疾人权利公约》为核心,并以联合国及WHO发表的辅助技术服务的相关政策文件为基础形成的,其主旨在于发展辅助技术服务,为残疾人、老年人和其他功能障碍者提供及时、适当和可负担的辅助技术服务,改善他们的健康并提升生活质量和福祉。要将辅助技术纳入全民健康覆盖,并通过初级卫生保健加强服务提供,以实现联合国可持续发展目标三全民健康覆盖的目标,实现辅助技术服务全覆盖。发展辅助技术,要将辅助技术纳入康复服务的范畴,在WHO健康服务体系的六大构成要素架构下,完善辅助技术服务的治理,通过多种机制为辅助技术服务进行筹资,培训康复人才从事辅助技术工作,改善辅助技术的服务提供,提升服务的质量,将辅助技术纳入基本医药技术,建立适应辅助技术发展的健康信息系统并对辅助技术服务提供监测。在世界不同地区,由于经济和社会发展水平的差异,辅助产品和技术服务的发展水平存在着很大差异,在获得辅助技术服务时遇到很大挑战。需要制定相关的政策、规划,并进行技术和服务创新。未来辅助技术发展将围绕辅助技术的5P模式进行产品和服务提供领域的改革以及技术创新,以提升辅助技术服务的覆盖率、有效性、可及性和可负担性,在全民健康覆盖架构下,将辅助技术服务融入健康服务体系,实现全民辅助技术服务全覆盖,提升辅助技术服务的质量和辅助技术消费者的福祉。     

Quadriceps strength in intensive care unit survivors: Variability and influence of preadmission physical activity

BackgroundMuscle weakness is common in patients who survive a stay in the intensive care unit (ICU). Quadriceps strength (QS) measurement allows evaluation of lower limb performances that are associated with mobility outcomes.ObjectivesThe objective of the study was to characterise the range of QS in ICU survivors (ICUS) during their short-term evolution, by comparing them with surgical patients without critical illness and with healthy participants. The secondary aim was to explore whether physical activity before ICU admission influenced QS during that trajectory.MethodsPatients with length of ICU stay ≥2 days, adults scheduled for elective colorectal surgery, and young healthy volunteers were included. Maximal isometric QS was assessed using a handheld dynamometer and a previously validated standardised protocol. The dominant leg was tested in the supine position. ICUSs were tested in the ICU and 1 month after ICU discharge, while surgical patients were tested before and on the day after surgery, as well as 1 month after discharge. Healthy patients were tested once only. Patients were classified as physically inactive or active before admission from the self-report.ResultsThirty-eight, 32, and 34 participants were included in the ICU, surgical, and healthy groups, respectively. Demographic data were similar in the ICUS and surgical groups. In the ICU, QS was lower in the ICU group than in the surgical and healthy groups (3.01 [1.88–3.48], 3.38 [2.84–4.37], and 5.5 [4.75–6.05] N/kg, respectively). QS did not significantly improve 1 month after ICU discharge, excepted in survivors who were previously physically active (22/38, 56%): the difference between the two time points was ?6.6 [?27.1 to ?1.7]% vs 20.4 [?3.4 to 43.3]%, respectively, in physically inactive and active patients (p = 0.002).ConclusionsPatients who survived an ICU stay were weaker than surgical patients. However, a huge QS heterogeneity was observed among them. Their QS did not improve during the month after ICU discharge. Physically inactive patients should be early identified as at risk of poorer recovery.     

Effect of releasing quadratus lumborum muscle on hip and knee muscle length in asymptomatic individuals

BackgroundQuadratus lumborum muscle (QL) is one of several muscles subject to tightness and relevant to symptoms in the back and hip. Although releasing the tight QL seems to resolve these symptoms in clinic, no study has investigated the effects of such releasing on the length of the hip and knee muscles.ObjectiveTo compare muscle length of the hip and knee joints between pre- and post-releasing the QL.MethodsA quasi-experimental design (one-group pretest-posttest design) was conducted. Thirty asymptomatic participants with mean age of 20.40 years took part in the study. An examiner assessed the participants’ pelvic transverse gliding movement in standing and rotation of the upper trunk in supine to perceive the end feel of tissue resistance. The side with perceived more muscle tension was selected for receiving muscle release. Before manually releasing the QL, the participant was in the modified Thomas test position and pre-test range of motion (ROM) of hip flexion, hip abduction, and knee flexion angles was measured using a standard goniometer. After releasing the QL, the aforementioned angles were measured for post-test ROM.ResultsThe hip flexion angle was significantly reduced after releasing the QL (p < 0.05), whereas no statistically significant differences were found for the other 2 angles (p > 0.05).ConclusionThe length of iliopsoas muscle was increased after releasing the QL. The findings may be due to continuous fascial connection and similar attachment of the origins of these 2 muscles.Clinical trial registration numberNCT03016559.