A.C.T.I.V.E. AGEING (Adapted Controlled Training Individualised through Verification in the Elderly): an innovative comprehensive multifactorial evaluation for the planning and monitoring of Adapted Physical Activity in the elderl

Purpose: The project A.C.T.I.V.E. AGEING herein presented is part of an extended ambitious interdisciplinary, multifactorial project started by our group. The project aims to bring back to more active and physically efficient life, elderly people. The general framework is to build individualised adapted physical activities (APA) to contrast sedentary lifestyle, sarcopenia and low-grade chronic inflammatory status (Inflammaging) to prevent immobility syndrome in the elderly. Individualised APA for the elderly is necessary to avoid the overwhelming physical-psychological stress that could lead to failure with reduced functional efficiency, increased pain, subsequent lack of motivation and abandonment of training programmes. Methods: To achieve the \u2018\u2018proper individualised APA\u2019\u2019 and to monitor its effect on the elderly a number of quantitative measurements are planned: 1. Anthropometry including plicometry and measurement of circumferences. 2. Battery of Validated Functional Tests: a. Five Times Sit-to-Stand Test (FTSST) and Timed Up-andGo test (TUG). b. Maximal Voluntary Contraction (MVC) of quadriceps. 3. Comprehensive Multifactorial Biomechanical Analysis (CMBA) of full 3D skeleton Posture and Movement using new technological Opto-Electronic tereophotogrammetric devices in conjunction with Baropodometric and Surface Electro-Myographic devices [1, 2]. 4. Bio-histo-chemical analysis through muscle biopsy to measure exercise-associated muscle structure changes. Twenty participants (age 71.77 \ub1 4.06 years) were subdivided randomly into 2 groups: controls (n.10 subjects no APA); resistance training APA supplemented with neuro-muscular electrical stimulation (10 subjects). Two-way ANOVA for repeated measures was used to analyse differences between groups and over pre (T0)-and post (T1) after 12 weeks APAs. Results: The groups presented no differences at T0, while as expected the APA group showed improvements at T1 in: FTSST, TUG, MVC, CMBA and in muscle structure. Conversely, 12 weeks period of APA revealed to be insufficient to find significant changes in anthropometry. All participants reported an optimal compliance with planned level of APA. Conclusions: The described general framework proved to be effective to plan and monitor \u2018\u2018proper individualised APA\u2019\u2019. It demonstrates the importance to collect multifactorial data and integrate them into a unique framework, providing a real added value in the detailed comprehension of functional and biomechanical phenomena

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)