Mortality of patients with COPD participating in chronic disease management programmes: a happy end?

BACKGROUND: Concerns about increased mortality could question the role of COPD chronic disease management (CDM) programmes. We aimed at extending a recent Cochrane review to assess the effects of CDM on mortality in patients with COPD. METHODS: Mortality data were available for 25 out of 29 trials identified in a COPD integrated care systematic review. Meta-analysis using random-effects models was performed, followed by subgroup analyses according to study length (3-12 months vs >12 months), main intervention component (exercise, self-management, structured follow-up) and use of an action plan. RESULTS: The meta-analysis showed no impact of CDM on mortality (pooled OR: 1.00, 95% CI 0.79 to 1.28). CONCLUSIONS: These results do not suggest that CDM programmes expose patients with COPD to excessive mortality risk.

Four decades of the independent study programmes

Sobre l'Independent Studies Programme (ISP) i el Programa d’Estudis Independents (PEI) del MACBA

Computed tomography commissioning programmes: how to obtain a reliable MTF with an automatic approach?

The purpose of this study was to assess the spatial resolution of a computed tomography (CT) scanner with an automatic approach developed for routine quality controls when varying CT parameters. The methods available to assess the modulation transfer functions (MTF) with the automatic approach were Droege's and the bead point source (BPS) methods. These MTFs were compared with presampled ones obtained using Boone's method. The results show that Droege's method is not accurate in the low-frequency range, whereas the BPS method is highly sensitive to image noise. While both methods are well adapted to routine stability controls, it was shown that they are not able to provide absolute measurements. On the other hand, Boone's method, which is robust with respect to aliasing, more resilient to noise and provides absolute measurements, satisfies the commissioning requirements perfectly. Thus, Boone's method combined with a modified Catphan 600 phantom could be a good solution to assess CT spatial resolution in the different CT planes.

Ancrage de la légitimité économique dans les filières académiques: une approche représentationnelle de la socialisation et de l'autosélection

Cette recherche articule des processus de socialisation et d'auto-sélection à partir d'une perspective de représentations sociales (RS). Les deux études présentées montrent comment le passage dans une filière universitaire, par un phénomène de socialisation qui succède à un processus d'auto-sélection, permet d'ancrer les prises de position dans des groupes. L'Etude 1 (N = 177) montre que les étudiant-e-s interrogé-e-s choisissent leur filière en fonction des études menées avant l'entrée à l'université, et que les étudiant-e-s en commerce et en droit prennent plus fortement position en faveur de l'économie libérale que les étudiant-e-s des sciences sociales et politiques et des lettres. Les résultats de l'Etude 2 (N = 92) indiquent que ces prises de position normatives sont stables au fil des ans en commerce et qu'elles remettent de plus en plus en question l'économie libérale en sciences sociales et politiques. Enfin, les prises de position dépendent de l'orthodoxie des connaissances économiques, une mesure de la perception de la valeur explicative des connaissances économiques qui est propre aux filières.

Variation in performance in low-volume mammography screening programmes: experience from Switzerland.

BACKGROUND: Reading volume and mammography screening performance appear positively correlated. Quality and effectiveness were compared across low-volume screening programmes targeting relatively small populations and operating under the same decentralised healthcare system. Except for accreditation of 2nd readers (restrictive vs non-restrictive strategy), these organised programmes had similar screening regimen/procedures and duration, which maximises comparability. Variation in performance and its determinants were explored in order to improve mammography practice and optimise screening performance. METHODS: Circa 200,000 screens performed between 1999 and 2006 (4 rounds) in 3 longest standing Swiss cantonal programmes (of Vaud, Geneva and Valais) were assessed. Indicators of quality and effectiveness were assessed according to European standards. Interval cancers were identified through linkage with cancer registries records. RESULTS: Swiss programmes met most European standards of performance with a substantial, favourable cancer stage shift. Up to a two-fold variation occurred for several performance indicators. In subsequent rounds, compared with programmes (Vaud and Geneva) that applied a restrictive selection strategy for 2nd readers, proportions of in situ lesions and of small cancers (≤1cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. CONCLUSION: Differences in performance could partly be explained by a selective strategy for second readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume programmes.