Background: Mechanically ventilated patients are at risk of developing inspiratory muscle weakness (IMW), which is associated with failure to wean and poor outcomes. Inspiratory muscle training (IMT) is a recommended intervention during and after extubation but has not been widely adopted in Dutch intensive care units (ICUs). Objectives: The objective of this study was to explore the potential, barriers, and facilitators for implementing IMT as treatment modality for mechanically ventilated patients. Methods: This mixed-method, proof-of-concept study was conducted in a large academic hospital in the Netherlands. An evidence-based protocol for assessing IMW and training was applied to patients ventilated for ≥24 h in the ICU during an 8-month period in 2021. Quantitative data on completed measurements and interventions during and after ICU-stay were collected retrospectively and were analysed descriptively. Qualitative data were collected through semistructured interviews with physiotherapists executing the new protocol. Interview data were transcribed and thematically analysed. Findings: Of the 301 screened patients, 11.6% (n = 35) met the inclusion criteria. Measurements were possible in 94.3% of the participants, and IMW was found in 78.8% of the participants. Ninety-six percent started training in the ICU, and 88.5% continued training after transfer to the ward. Follow-up measurements were achieved in 73.1% of the patients with respiratory muscle weakness. Twelve therapists were interviewed, of whom 41.7% regularly worked in the ICU. When exploring reasons for protocol deviation, three themes emerged: “professional barriers”, “external factors”, and “patient barriers”. Conclusions: Implementation of measurements of and interventions for IMW showed to be challenging in this single centre study. Clinicians' willingness to change their handling was related to beliefs regarding usefulness, effectiveness, and availability of time and material. We recommend that hospitals aiming to implement IMT during or after ventilator weaning consider these professional and organisational barriers for implementation of novel, evidence-based interventions into daily clinical practice.
MULTIFILE
Objective: In myocardial perfusion single-photon emission computed tomography (SPECT), abdominal activity often interferes with the evaluation of perfusion in the inferior wall, especially after pharmacological stress. In this randomized study, we examined the effect of carbonated water intake versus still water intake on the quality of images obtained during myocardial perfusion images (MPI) studies. Methods: A total of 467 MIBI studies were randomized into a carbonated water group and a water group. The presence of intestinal activity adjacent to the inferior wall was evaluated by two observers. Furthermore, a semiquantitative analysis was performed in the adenosine subgroup,using a count ratio of the inferior myocardial wall and adjacent abdominal activity. Results: The need for repeated SPECT in the adenosine studies was 5.3 % in the carbonated water group versus 19.4 % in the still water group (p = 0.019). The inferior wall-to-abdomen count ratio was significantly higher in the carbonated water group compared to the still water group (2.11 ± 1.00 vs. 1.72 ± 0.73, p\0.001). The effect of carbonated water during rest and after exercise was not significant. Conclusions: This randomized study showed that carbonated water significantly reduced the interference of extra-cardiac activity in adenosine SPECT MPI. Keywords: Extra-cardiac radioactivity, Myocardial SPECT, Image quality enhancement, Carbonated water
Injuries and lack of motivation are common reasons for discontinuation of running. Real-time feedback from wearables can reduce discontinuation by reducing injury risk and improving performance and motivation. There are however several limitations and challenges with current real-time feedback approaches. We discuss these limitations and challenges and provide a framework to optimise real-time feedback for reducing injury risk and improving performance and motivation. We first discuss the reasons why individuals run and propose that feedback targeted to these reasons can improve motivation and compliance. Secondly, we review the association of running technique and running workload with injuries and performance and we elaborate how real-time feedback on running technique and workload can be applied to reduce injury risk and improve performance and motivation. We also review different feedback modalities and motor learning feedback strategies and their application to real-time feedback. Briefly, the most effective feedback modality and frequency differ between variables and individuals, but a combination of modalities and mixture of real-time and delayed feedback is most effective. Moreover, feedback promoting perceived competence, autonomy and an external focus can improve motivation, learning and performance. Although the focus is on wearables, the challenges and practical applications are also relevant for laboratory-based gait retraining.
Aanleiding: Automatisering kan leiden tot beter gebruik van materialen en afval reduceren. Dit brengt verbeteringen met zich mee voor 'people, planet and profit' (PPP) - mensen, het milieu en de winst. Een specifieke vorm van automatisering, de ontwikkeling van zelfrijdende auto's en vrachtauto's, gaat snel. Maar om zelfrijdende voertuigen beschikbaar te maken is er nog veel onderzoek en ontwikkeling nodig op verschillende gebieden. Er zijn nog veel vragen te beantwoorden op het gebied van onder andere truckontwerp, betrouwbare software, aansprakelijkheid, trajectplanning en logistiek. Doelstelling Het doel van het Intralog-project is om voor de maatschappij en de private sector een significante bijdrage te leveren aan de mogelijkheden van zelfrijdende voertuigen in de commerciële transportsector. Het Intralog-project onderzoekt de toegevoegde waarde voor PPP van 'automated guided trucks' (AGT's) aan logistieke operaties bij distributiecentra en interterminal/intermodal traffic hubs. Dit gebeurt in twee stappen: 1) het identificeren van het potentieel met betrekking tot de vraag vanuit de logistieke omgeving; 2. het ontwerpen, realiseren, testen en valideren van mogelijke strategieën voor het implementeren van AGT's in een logistiek scenario. Beoogde resultaten Het concrete resultaat van het project bestaat uit onderzoekstools en hardware- en softwaremodellen voor Intralog. Deze bieden een goede mogelijkheid om de opgedane kennis te verspreiden. De projectdeelnemers zullen bijdragen aan workshops, tentoonstellingen en in Nederland georganiseerde symposia. De onderzoeksresultaten verspreiden ze op conferenties en door middel van publicaties in technische vakbladen. De uiteindelijke Intralog-resultaten worden gepresenteerd op een afsluitend congres. De resultaten zullen worden samengevat in een boekje.
