Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP) guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT). The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice. Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients. Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction,more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT. Conclusion. Unequalpatient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT.
A loss of physical functioning (i.e., a low physical capacity and/or a low physical activity) is a common feature in patients with chronic obstructive pulmonary disease (COPD). To date, the primary care physiotherapy and specialized pulmonary rehabilitation are clearly underused, and limited to patients with a moderate to very severe degree of airflow limitation (GOLD stage 2 or higher). However, improved referral rates are a necessity to lower the burden for patients with COPD and for society. Therefore, a multidisciplinary group of healthcare professionals and scientists proposes a new model for referral of patients with COPD to the right type of exercise-based care, irrespective of the degree of airflow limitation. Indeed, disease instability (recent hospitalization, yes/no), the burden of disease (no/low, mild/moderate or high), physical capacity (low or preserved) and physical activity (low or preserved) need to be used to allocate patients to one of the six distinct patient profiles. Patients with profile 1 or 2 will not be referred for physiotherapy; patients with profiles 3–5 will be referred for primary care physiotherapy; and patients with profile 6 will be referred for screening for specialized pulmonary rehabilitation. The proposed Dutch model has the intention to get the right patient with COPD allocated to the right type of exercise-based care and at the right moment.
OBJECTIVES: Expiratory muscle strength training (EMST) is a threshold based device-driven treatment for improving expiratory pressure. EMST proved to be effective in different patient groups to improve cough function. To date, EMST has not been tested in the total laryngectomy population (TL).METHODS: This prospective, randomized case-series study examined feasibility, safety, and compliance of EMST in a group of TL participants and its effects on pulmonary function, physical exertion, fatigue, and vocal functioning. Ten TL participants were included in the study to perform a 4 till 8 weeks of EMST. Objective and subjective outcome measures included manometry, spirometry, cardio pulmonary exercise testing (CPET), voice recordings, and patient reported outcome measures. Group means were reported and estimates of the effect are shown with a 95% confidence interval, using single sample t-tests.RESULTS: Nine participants completed the full study protocol. Compliance to the training program was high. All were able to perform the training, although it requires adjustments of the device and skills of the participants. Maximum expiratory pressure (MEP) and vocal functioning in loudness improved over time. After EMST no changes were seen in other objective and subjective outcomes.CONCLUSIONS: EMST appears to be feasible and safe after total laryngectomy. MEP improved over time but no improvement in the clinically relevant outcome measures were seen in this sample of relatively fit participants. Further investigation of the training in a larger group of participants who report specifically pulmonary complaints is recommended to investigate if the increase in MEP results in clinical benefits.LEVEL OF EVIDENCE: 4.
Ambtenaren openbare orde en veiligheid spelen een centrale rol in de zorg voor maatschappelijke veiligheid. Hun focus ligt van oudsher op de preventie van slachtofferschap van veelvoorkomende criminaliteit (zoals diefstal, vernielingen en vandalisme) en high impact crime (zoals woninginbraak, overvallen en straatroven) binnen hun verzorgingsgebied. Intussen heeft de digitalisering van de samenleving een ongeëvenaarde gelegenheid voor criminaliteit gecreëerd. De totale maatschappelijke schade van cybercrime werd voor 2018 op 10 miljard euro geschat (1% van BNP). Uit cijfers van het CBS blijkt dat tussen 2012 en 2018 het slachtofferschap van hacken zelfs hoger lag dan dat van fietsendiefstal. Nederlandse gemeenten hebben cybercrime in de afgelopen twee jaar dan ook breed als beleidsprioriteit omarmd. Maar in de vertaling van deze beleidsprioriteit naar concrete acties gaat het mis. Duidelijk is dat de ambtenaren openbare orde en veiligheid een taak voor zichzelf zien in de preventie van cybercrime, maar waar te beginnen? In dit project bundelen professionals uit twaalf gemeenten en vier regionale veiligheidsnetwerken hun slagkracht met onderzoekers van twee hogescholen en het NSCR voor de cyberweerbaarheid van de samenleving. De hoofdvraag van dit project luidt: Met welke interventies kunnen ambtenaren openbare orde en veiligheid de cyberweerbaarheid van burgers en bedrijven binnen hun gemeente vergroten? Middels actieonderzoek werken professionals van gemeenten en regio’s samen met onderzoekers aan het verbeteren van bestaande en het ontwikkelen van nieuwe interventies. Daarbij verscherpen zij hun beeld van de omvang en achtergronden van slachtofferschap van cybercrime. Ook onderzoeken zij achtergronden en verklaringen voor het risicobewustzijn en preventief gedrag onder doelgroepen. Deze inzichten worden in verschillende iteraties aangevuld met effectstudies, om tot een set beproefde interventies te komen waarmee de cyberweerbaarheid van burgers en bedrijven zal toenemen.
