Liver mobilization was helpful for managing difficult urological tumors. Patients with a retrohepatic or even suprahepatic inferior vena caval thrombus may be treated without sternotomy or thoracotomy and cardiopulmonary bypass.

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Purpose: To describe current mobilization practices of Canadian physiotherapists when treating patients with external ventricular drains (EVDs). Methods: A quantitative, descriptive, cross-sectional study design using an online questionnaire via SurveyMonkey. An email invitation and questionnaire link was distributed in March 2010 to physiotherapists currently working with this patient population in Neurosurgical Centres across Canada. Results: Respondents were 25 physiotherapists (21 full-time, 2 part-time, and 2 who did not disclose work status) working in 5 different provinces who treated b1 patient/ month with an EVD (n ¼ 9). Slightly more than half of respondents had a10 years' clinical physiotherapy experience (n ¼ 14); the remainder had >10 years' experience (n ¼ 11). The majority of respondents indicated that they felt comfortable mobilizing patients with EVDs (n ¼ 19) and that it was safe to do so (n ¼ 20). Clinical experience (n ¼ 23) and safety concerns (n ¼ 25) were most commonly cited as guiding practice. More experienced physiotherapists were more likely to use out-of-bed mobilization practices. Regardless of experience, the majority of physiotherapists (20/25) ranked intracranial pressure (ICP) as the most important factor and saturation of oxygen (Spo 2 ) as the least important factor to consider before mobilization. Conclusions: Canadian physiotherapists are mobilizing patients with EVDs, and the intensity level of their mobilization practices appears to be related to their experience level. Data from the current study may be used in developing future best-practice guidelines for the mobilization of patients with EVDs.Key Words: clinical experience; clinical reasoning; external ventricular drain; mobilization. RÉ SUMÉObjectif : Dé crire les mé thodes actuelles de mobilisation pratiqué es par les physiothé rapeutes canadiens qui traitent des patients avec des drains ventriculaires externes (DVE). Mé thodes : É tude transversale descriptive quantitative basé e sur un questionnaire en ligne administré via SurveyMonkey. Une invitation é lectronique comportant un lien vers le questionnaire a é té distribué e en mars 2010 aux physiothé rapeutes qui travaillent actuellement avec cette population dans les centres de neurochirurgie du Canada. Ré sultats : Les ré pondants é taient 25 physiothé rapeutes travaillant (21 à temps plein, 2 à temps partiel, 2 qui n'ont pas ré vé lé leur statut) dans cinq provinces diffé rentes qui ont traité b1 patient/mois au moyen de DVE (n ¼ 9). Un peu plus de la moitié des ré pondants comptaient a10 ans d'expé rience de la physiothé rapie clinique (n ¼ 14); les autres en comptaient >10 (n ¼ 11). La majorité des ré pondants ont indiqué se sentir à l'aise de mobiliser cette population (n ¼ 19) et qu'il é tait sé curitaire de le faire (n ¼ 20). L'expé rience clinique (n ¼ 23) et les pré occupations en matiè re de sé curité (n ¼ 25) ont é té les facteurs mentionné s le plus souvent comme guide de pratique. La plupart des physiothé rapeutes chevronné s é taient plus susc...

Objective.To compare clinical impression and confidence of extended role practitioners (ERP) with those of rheumatologists experienced in axial spondyloarthritis (axSpA) according to (1) evaluation of patients with chronic back pain assessed for axSpA; and (2) magnetic resonance imaging (MRI) recommendation for further investigation of these patients.Methods.Patients with ≥ 3 months of back pain and age of onset < 45 years were referred for axSpA evaluation. An ERP assessed consecutive patients and recorded standardized clinical information in written form. Three rheumatologists subsequently evaluated each patient based on the recorded information. Patients were classified as having axSpA or mechanical back pain based on clinical and investigative findings. Level of confidence was noted for classification and MRI indication. Agreement between assessors was evaluated using percentage agreement and κ coefficient.Results.Fifty-seven patients were assessed. Interobserver agreement of clinical impression for all raters was moderate (κ = 0.52). Agreement of clinical impression between ERP and rheumatologists ranged between 71.2% (κ = 0.41) and 79.7% (κ = 0.57). Agreement of clinical impression among rheumatologists ranged from 74.1% (κ = 0.49) to 79.7% (κ = 0.58). All rater agreement for MRI indication was fair (κ = 0.37). ERP agreement with rheumatologist for MRI recommendation ranged from 64.2% (κ = 0.32) to 75% (κ = 0.48). Agreement for MRI indication among rheumatologists ranged from 62.9% (κ = 0.27) to 74% (κ = 0.47). Confidence in clinical impression was similar among all practitioners.Conclusion.ERP with specialty training in inflammatory arthritis demonstrate clinical impressions comparable with those of rheumatologists in the assessment of axSpA. Incorporation of such roles into existing models of care may assist in early detection of axSpA.

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Results: After 6 months of training intensity of back pain was significantly (p <0.01) decreased by 2.5 times in the primary group and by 1.5 times fold in control, 52% of patients from the primary group, and 37.5% -in the control wore an orthopedic corset. 95.8% of patients who visited schools and 90% of patients in the control group were continuously taking calcium and vitamin D during 6 months,after 12 months -93.7% and 85% respectively. Pathogenetic therapy was applied to all patients, initially these drugs began to take 97.9% of the study group and 92.5% of the control group patients, after 6 months of continuous administration of drugs 89.5% from group trained patients and 67.5% -the control group continued treatment, after 12 months commitment to therapy was 87.5% and 42.5% in the test and control groups, respectively. Densitometry results in dynamics after 12 months showed that the increase in BMD was significantly (p <0.05) higher in the group that has been schooled for the patients and was 5,6 ± 6,2% at the spine, 4,2 ± 4,5% at the femoral neck in the main group, 3,1 ± 4,8% and 1,9 ± 3,2% respectively in the control group. Conclusions: Educational programs improve functional status and quality of patients life, remain high compliance of therapy, increase commitment to treatment. Background:In 2009, patient education was recognised as a full component of care for patients with chronic diseases by the French Law HPST ("hospital, patients, health, territories"). As per January 2011, physicians and health professionals teams were allowed to run patient education only after having received a formal agreement from their territorial health agency (ARS), under precise conditions, published at the national level. A yearly report to the ARS became mandatory. The French society of rheumatology created a working group for patient education, devoted to its optimisation at the national level. Objectives: To make an inventory of the agreements for patient education in rheumatology and to collect the main points of the teams' first year activity report, at the national level. Methods: We run a national survey via the website of the French Society of Rheumatology, using two questionnaires, early 2011 (patient education programs and agreements) and early 2012 (evaluation of the 1st year of working according to the new rules). Results: 56 answers were collected (all from hospital rheumatology teams), gathering 70 agreements out of 91 requests. The approved programs were targeted on inflammatory joint disorders (25), RA (18), SA (9), osteoporosis (5), low back pain (5), chronic pain (2), rare diseases (6). The experience of the first year of working under the new Law was coherent with the previsions of the patient education teams in 22 cases out of 32 answers. The main reported difficulties (27 answers) were : lack of staff (16), of financial resources (8), recruitment (2), patient motivation (2), lack of recognition (1).… 15 teams (out of 28 answers) were likely to submit new requests for agreement, for osteoporosis (9), ...

Objective. To evaluate a stratified screening process for the early identification of axial spondyloarthritis (SpA) with consideration of the following: 1) wait times from primary care to rheumatology screen, 2) incremental precision and accuracy from primary care to rheumatology screening, and 3) diagnostic delay.Methods. Adults with low back pain attending primary care at low back pain clinics prospectively underwent a primary standardized clinical screening. Patients with low back pain of >3 months who experienced symptom onset at age <50 years were referred for a comprehensive secondary screening by a physical therapist with advanced rheumatology training. At secondary screening, patients with features of inflammation were classified as being at a low, medium, or high risk for axial SpA versus no risk for axial SpA. Precision and accuracy of this screening strata were measured against a rheumatologist with expertise in axial SpA.Results. Overall, 405 patients underwent primary and secondary screening in the present study. The study cohort had a mean AE SD age of 36.9 AE 9.9 years, and 55% were women. HLA-B27 was present in 14.4% of patients. Median wait time from primary screening to secondary screening was 15 days. Axial SpA risk assignment by rheumatologist was 64.9% for no risk or low risk for axial SpA and 35.1% for medium risk or high risk for axial SpA. The best combination of sensitivity (68%), specificity (90%), positive predictive values (80%), and negative predictive values (84%) was evident in the secondary screening. In this cohort, 15.6% of patients received a final diagnosis of axial SpA. Median low back pain duration from symptom onset to diagnosis was 2 years for nonradiographic axial SpA and 7 years for ankylosing spondylitis. Conclusion.A stratified interprofessional screening process can facilitate rapid diagnosis of persistent low back pain with high precision and accuracy in patients who have axial SpA.