Use of Video Decision Aids to Promote Advance Care Planning in Hilo, Hawai‘i

Introduction: Advance care planning (ACP) seeks to promote care delivery that is concordant with patients’ informed wishes. Scalability and cost may be barriers to widespread ACP, and video decision aids may help address such barriers. Aim Our primary hypothesis was that ACP documentation would increase in Hilo after ACP video implementation. Secondary hypotheses included increased use of hospice, fewer deaths in the hospital, and decreased costs in the last month of life. Setting: The city of Hilo in Hawai‘i (population 43,263), which is served by one 276-bed hospital (Hilo Medical Center), one hospice (the Hospice of Hilo), and 30 primary care physicians. Program Description The intervention consisted of a single, 1- to 4-h training and access to a suite of ACP video decision aids. Program Evaluation Prior to implementation, the rate of ACP documentation for hospitalized patients with late-stage disease was 3.2 % (11/346). After the intervention, ACP documentation was 39.9 % (1,107/2,773) (P < 0.001). Primary care providers in the intervention had an ACP completion rate for patients over 75 years of 37.0 % (1,437/3,888) compared to control providers, who had an average of 25.6 % (10,760/42,099) (P < 0.001). The rate of discharge from hospital to hospice for patients with late-stage disease was 5.7 % prior to the intervention and 13.8 % after the intervention (P < 0.001). The average total insurance cost for the last month of life among Hilo patients was $3,458 (95$3,051 to 3,865) lower per patient after the intervention when compared to the control region. Discussion Implementing ACP video decision aids was associated with improved ACP documentation, greater use of hospice, and decreased costs. Decision aids that promote ACP offer a scalable and cost-efficient medium to place patients at the center of their care. Electronic supplementary material The online version of this article (doi:10.1007/s11606-016-3730-2) contains supplementary material, which is available to authorized users

Relationships Between Eccentric and Concentric Knee Strength Capacities and Maximal Linear Deceleration Ability in Male Academy Soccer Players

Harper, DJ, Jordan, AR, and Kiely, J. Relationships between eccentric and concentric knee strength capacities and maximal linear deceleration ability in male academy soccer players. J Strength Cond Res XX(X): 000–000, 2018—The purpose of this study was to investigate the relationships between maximal linear deceleration ability, and knee flexor (KF) and knee extensor (KE) strength. Fourteen male academy soccer players completed a 30-m linear sprint, a maximal linear deceleration test, and eccentric and concentric KF and KE contractions in both dominant leg (DL) and nondominant leg (NDL) at slower (60°·s−1) and faster (180°·s−1) angular velocities on an isokinetic dynamometer. Maximal linear deceleration ability was evaluated using distance-to-stop (DEC-DTS) and time-to-stop (DEC-TTS), with isokinetic peak torque representing KF and KE strength capacity. Relationships were established using Pearson's correlation coefficients (r) with magnitude-based inferences used to describe the uncertainty in the correlation. Both concentric KE and KF strength at 180°·s−1 in the NDL had the highest correlations with deceleration ability (r = −0.76 and r = −0.78, respectively). In the DL, concentric KE and KF strength at 180°·s−1 also had very likely large correlations with deceleration ability (r = −0.54 and −0.55, respectively). All correlations between eccentric KF strength and deceleration ability were unclear. At 180°·s−1, correlations between eccentric KE strength and deceleration ability were also unclear; however, at 60°·s−1, both DL (r = −0.63 to −0.64) and NDL (r = −0.54 to −0.55) had very likely large correlations with deceleration ability. These findings provide novel insights into the unilateral KF and KE strength capacities underpinning the ability to decelerate rapidly from high-sprint velocities

Relationships Between Eccentric and Concentric Knee Strength Capacities and Maximal Linear Deceleration Ability in Male Academy Soccer Players

Harper, DJ, Jordan, AR, and Kiely, J. Relationships between eccentric and concentric knee strength capacities and maximal linear deceleration ability in male academy soccer players. J Strength Cond Res 35(2): 465–472, 2021—The purpose of this study was to investigate the relationships between maximal linear deceleration ability, and knee flexor (KF) and knee extensor (KE) strength. Fourteen male academy soccer players completed a 30-m linear sprint, a maximal linear deceleration test, and eccentric and concentric KF and KE contractions in both dominant leg (DL) and nondominant leg (NDL) at slower (60°·s−1) and faster (180°·s−1) angular velocities on an isokinetic dynamometer. Maximal linear deceleration ability was evaluated using distance-to-stop (DEC-DTS) and time-to-stop (DEC-TTS), with isokinetic peak torque representing KF and KE strength capacity. Relationships were established using Pearson's correlation coefficients (r) with magnitude-based inferences used to describe the uncertainty in the correlation. Both concentric KE and KF strength at 180°·s−1 in the NDL had the highest correlations with deceleration ability (r = −0.76 and r = −0.78, respectively). In the DL, concentric KE and KF strength at 180°·s−1 also had very likely large correlations with deceleration ability (r = −0.54 and −0.55, respectively). All correlations between eccentric KF strength and deceleration ability were unclear. At 180°·s−1, correlations between eccentric KE strength and deceleration ability were also unclear; however, at 60°·s−1, both DL (r = −0.63 to −0.64) and NDL (r = −0.54 to −0.55) had very likely large correlations with deceleration ability. These findings provide novel insights into the unilateral KF and KE strength capacities underpinning the ability to decelerate rapidly from high-sprint velocities