Evaluating the Impact of a ‘Virtual Clinic’ on Patient Experience, Personal and Provider Costs of Care in Urinary Incontinence: A Randomised Controlled Trial.

Objective: To evaluate the impact of using a ‘virtual clinic’ on patient experience and cost in the care of women with urinary incontinence. Materials and Methods: Women, aged > 18 years referred to a urogynaecology unit were randomised to either (1) A Standard Clinic or (2) A Virtual Clinic. Both groups completed a validated, web-based interactive, patient-reported outome measure (ePAQ-Pelvic Floor), in advance of their appointment followed by either a telephone consultation (Virtual Clinic) or face-to-face consultation (Standard Care). The primary outcome was the mean ‘short-term outcome scale’ score on the Patient Experience Questionnaire (PEQ). Secondary Outcome Measures included the other domains of the PEQ (Communications, Emotions and Barriers), Client Satisfaction Questionnaire (CSQ), Short-Form 12 (SF-12), personal, societal and NHS costs. Results: 195 women were randomised: 98 received the intervention and 97 received standard care. The primary outcome showed a non-significant difference between the two study arms. No significant differences were also observed on the CSQ and SF-12. However, the intervention group showed significantly higher PEQ domain scores for Communications, Emotions and Barriers (including following adjustment for age and parity). Whilst standard care was overall more cost-effective, this was minimal (£38.04). The virtual clinic also significantly reduced consultation time (10.94 minutes, compared with a mean duration of 25.9 minutes respectively) and consultation costs compared to usual care (£31.75 versus £72.17 respectively), thus presenting potential cost-savings in out-patient management. Conclusions: The virtual clinical had no impact on the short-term dimension of the PEQ and overall was not as cost-effective as standard care, due to greater clinic re-attendances in this group. In the virtual clinic group, consultation times were briefer, communication experience was enhanced and personal costs lower. For medical conditions of a sensitive or intimate nature, a virtual clinic has potential to support patients to communicate with health professionals about their condition

Correction: International Society of Sports Nutrition position stand: Nutrient timing

Position Statement: The position of the Society regarding nutrient timing and the intake of carbohydrates, proteins, and fats in reference to healthy, exercising individuals is summarized by the following eight points: 1.) Maximal endogenous glycogen stores are best promoted by following a high-glycemic, high-carbohydrate (CHO) diet (600 – 1000 grams CHO or ~8 – 10 g CHO/kg/d), and ingestion of free amino acids and protein (PRO) alone or in combination with CHO before resistance exercise can maximally stimulate protein synthesis. 2.) During exercise, CHO should be consumed at a rate of 30 – 60 grams of CHO/hour in a 6 – 8% CHO solution (8 – 16 fluid ounces) every 10 – 15 minutes. Adding PRO to create a CHO:PRO ratio of 3 – 4:1 may increase endurance performance and maximally promotes glycogen re-synthesis during acute and subsequent bouts of endurance exercise. 3.) Ingesting CHO alone or in combination with PRO during resistance exercise increases muscle glycogen, offsets muscle damage, and facilitates greater training adaptations after either acute or prolonged periods of supplementation with resistance training. 4.) Post-exercise (within 30 minutes) consumption of CHO at high dosages (8 – 10 g CHO/kg/day) have been shown to stimulate muscle glycogen re-synthesis, while adding PRO (0.2 g – 0.5 g PRO/kg/day) to CHO at a ratio of 3 – 4:1 (CHO: PRO) may further enhance glycogen re-synthesis. 5.) Post-exercise ingestion (immediately to 3 h post) of amino acids, primarily essential amino acids, has been shown to stimulate robust increases in muscle protein synthesis, while the addition of CHO may stimulate even greater levels of protein synthesis. Additionally, pre-exercise consumption of a CHO + PRO supplement may result in peak levels of protein synthesis. 6.) During consistent, prolonged resistance training, post-exercise consumption of varying doses of CHO + PRO supplements in varying dosages have been shown to stimulate improvements in strength and body composition when compared to control or placebo conditions. 7.) The addition of creatine (Cr) (0.1 g Cr/kg/day) to a CHO + PRO supplement may facilitate even greater adaptations to resistance training. 8.) Nutrient timing incorporates the use of methodical planning and eating of whole foods, nutrients extracted from food, and other sources. The timing of the energy intake and the ratio of certain ingested macronutrients are likely the attributes which allow for enhanced recovery and tissue repair following high-volume exercise, augmented muscle protein synthesis, and improved mood states when compared with unplanned or traditional strategies of nutrient intake

ISSN exercise & sport nutrition review: research & recommendations

Sports nutrition is a constantly evolving field with hundreds of research papers published annually. For this reason, keeping up to date with the literature is often difficult. This paper is a five year update of the sports nutrition review article published as the lead paper to launch the JISSN in 2004 and presents a well-referenced overview of the current state of the science related to how to optimize training and athletic performance through nutrition. More specifically, this paper provides an overview of: 1.) The definitional category of ergogenic aids and dietary supplements; 2.) How dietary supplements are legally regulated; 3.) How to evaluate the scientific merit of nutritional supplements; 4.) General nutritional strategies to optimize performance and enhance recovery; and, 5.) An overview of our current understanding of the ergogenic value of nutrition and dietary supplementation in regards to weight gain, weight loss, and performance enhancement. Our hope is that ISSN members and individuals interested in sports nutrition find this review useful in their daily practice and consultation with their clients

The effect of two β-alanine dosing strategies on 30-minute rowing performance: a randomized, controlled trial

Background: β-alanine (βA) supplementation has been shown to increase intramuscular carnosine content and subsequent high-intensity performance in events lasting <4 minutes, which may be dependent on total, as opposed to daily, dose. The ergogenic effect of βA has also been demonstrated for 2000-m rowing performance prompting interest in whether βA may be beneficial for sustained aerobic exercise. This study therefore investigated the effect of two βA dosing strategies on 30-minute rowing and subsequent sprint performance. Methods: Following University Ethics approval, twenty-seven healthy, male rowers (age: 24±2 years; body-height: 1.81±0.02m; body-mass: 82.3±2.5kg; body-fat: 14.2±1.0%) were randomised in a double-blind manner to 4 weeks of: i) βA (2.4 g·d-1, βA1); ii) matched total βA (4.8g on alternate days, βA2); or iii) cornflour placebo (2.4 g·d-1, PL). Participants completed a laboratory 30-minute rowing time-trial, followed by 3x30s maximal sprint efforts at days 0, 14 and 28 (T1-T3). Total distance (m), average power (W), relative average power (W·kg-1), cardio-respiratory measures and perceived exertion were assessed for each 10-minute split. Blood lactate ([La-]b mmol·L-1) was monitored pre-post time-trial and following maximal sprint efforts. A 3-way repeated measures ANOVA was employed for main analyses, with Bonferonni post-hoc assessment (P≤0.05). Results: Total 30-minute time-trial distance significantly increased from T1-T3 within βA1 only (7397±195m to 7580±171m, P=0.002, ƞp2 = 0.196), including absolute average power (194.8±18.3W to 204.2±15.5W, P=0.04, ƞp2=0.115) and relative average power output (2.28±0.15W·kg-1 to 2.41±0.12W·kg-1, P=0.031, ƞp2= 0.122). These findings were potentially explained by within-group significance for the same variables for the first 10 minute split (P≤0.01), and for distance covered (P=0.01) in the second 10-minute split. However, no condition x time interactions were observed. No significant effects were found for sprint variables (P>0.05) with comparable values at T3 for mean distance (βA1: 163.9±3.8m; βA2: 161.2±3.5m; PL: 162.7±3.6m), average power (βA1: 352.7±14.5W; βA2: 342.2±13.5W; PL: 348.2±13.9W) and lactate (βA1: 10.0±0.9mmol·L-1; βA2: 9.2±1.1mmol·L-1; PL: 8.7±0.9mmol·L-1). Conclusions: Whilst daily βA may confer individual benefits, these results demonstrate limited impact of βA (irrespective of dosing strategy) on 30-minute rowing or subsequent sprint performance. Further investigation of βA dosage > 2.4 g·d-1 and/or chronic intervention periods (>4-8 weeks) may be warranted based on within-group observations

Nursing record systems : effects on nursing practice and healthcare outcomes

Background - a nursing record system is the record of care that was planned or given to individual patients and clients by qualified nurses or other caregivers under the direction of a qualified nurse. Nursing record systems may be an effective way of influencing nurse practice.Objectives - to assess the effects of nursing record systems on nursing practice and patient outcomes.Search strategy - for the original version of this review in 2000, and updates in 2003 and 2008, we searched: the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register; MEDLINE, EMBASE, CINAHL, BNI, ISI Web of Knowledge, and ASLIB Index of Theses. We also handsearched: Computers, Informatics, Nursing (Computers in Nursing); Information Technology in Nursing; and the Journal of Nursing Administration. For this update, searches can be considered complete until the end of 2007.We checked reference lists of retrieved articles and other related reviews.Selection criteria - randomised controlled trials (RCTs), controlled before and after studies, and interrupted time series comparing one kind of nursing record system with another in hospital, community or primary care settings. The participants were qualified nurses, students orhealthcare assistants working under the direction of a qualified nurse, and patients receiving care recorded or planned using nursing record systems.Data collection and analysis - two review authors (in two pairs) independently assessed trial quality and extracted data

An investigative study into the influence of a commercially available carbohydrate-protein-electrolyte beverage on short term repeated exercise performance

Background: The purpose of this study was to undertake an independent investigation into the effects of ingesting a carbohydrate-protein-electrolyte (CPE) beverage on repeated submaximal and time-trial cycling performance. Methods: Sixteen recreationally trained males (height: 1.76 +/- 0.07 m; weight: 70.05 +/- 7.90 kg; VO2max: 49.69 +/- 4.19 ml.kg1.min1) performed two exercise trials separated by 7 days. Each trial comprised two bouts of 90 minutes exercise separated by a 2 hour recovery period. Each bout comprised 45 minutes exercise on a cycle-ergometer at 60%VO2max (ST), followed immediately by a 45 minute performance test (PT). Participants were randomly assigned an 8% CPE beverage or colour/taste matched placebo (PL) prior to each trial. Participants consumed 100 ml of the assigned beverage every 10 minutes during each ST, and 500 ml at 0 and 60 minutes into recovery (total caloric delivery per trial: 617.6 kcal for CPE and12.8 kcal for PL). Mean power output (W), speed (km.hr1) and distance covered (km) were assessed throughout both trials. Expired air was sampled at 10 minute intervals throughout ST. Blood glucose and lactate were assessed during ST and recovery. RESULTS: Distance covered during ST was significantly reduced with PL by 9.12% (20.18 +/- 0.28 km in ST1 v 18.34 +/- 0.36 km in ST2; P = 0.0001). With CPE, distance covered, power output and average speed were maintained between ST1 and ST2. Oxygen uptake was not significantly different between ST1 and ST2, or conditions. Respiratory exchange ratio (RER) values decreased from 0.98 +/- 0.02 in ST1 to 0.91 +/- 0.02 in ST2 for PL (P = 0.003), supporting reduced total carbohydrate oxidation rates (P = 0.007). Mean blood glucose was maintained in CPE across ST trials, and was significantly greater than PL in ST2 (4.77 +/- 0.09 mmol.L1 for CPE compared with 4.18 +/- 0.06 mmol.L1 for PL, P <0.001). Mean distance during PT2 was 2.96 km (or 17.1%) further with CPE than PL (P = 0.003). Mean power significantly decreased across PT with PL (134.21 +/- 4.79 W and 106.90 +/- 3.25 W, respectively; P <0.04). Conclusions: The use of a CPE beverage improves short-term repeated exercise and subsequent performance compared to PL. Higher rates of carbohydrate oxidation, maintenance of plasma glucose, and decreased levels of fatigue may be beneficial for secondary bouts of performance and faster recovery turnover.Peer reviewedFinal Published versio