Resistance exercise and nutritional interventions for augmenting sarcopenia outcomes in chronic kidney disease: a narrative review

Sarcopenia is an age-related progressive muscle disease characterized by loss of muscle mass, muscle strength and physical performance with high prevalence in chronic kidney disease (CKD). CKD is associated with decreased muscle protein synthesis and muscle breakdown due to a number of factors including, the uremic inflammatory environment of the disease. CKD patients are highly sedentary and at risk of malnutrition which may exacerbate sarcopenia outcomes even further. Short and long-term exercise and nutritional interventions have been studied and found to have some positive effects on sarcopenia measures in CKD. This narrative review summarized evidence between 2010 and 2020 of resistance exercise (RE) alone or combined with nutritional interventions for improving sarcopenia outcomes in CKD. Due to lack of CKD-specific sarcopenia measures, the second European Working Group on Sarcopenia in Older People (EWGSOP2) definition has been used to guide the selection of the studies. The literature search identified 14 resistance exercise-based studies and 5 nutrition plus RE interventional studies. Muscle strength outcomes were increased with longer intervention duration, intervention supervision, and high participant adherence. Data also suggested that CKD patients may require increased RE intensity and progressive loading to obtain detectable results in muscle mass. Unlike muscle strength and muscle mass, physical performance was readily improved by all types of exercise in long or short-term interventions. Four studies used RE with high-protein nutritional supplementation. These showed significant benefits on muscle strength and physical performance in dialysis patients while non-significant results were found in muscle mass. More research is needed to confirm if a combination of RE and vitamin D supplementation could act synergistically to improve muscle strength in CKD. The current evidence on progressive RE for sarcopenia in CKD is encouraging; however, real-life applications in clinical settings are still very limited. A multidisciplinary patient-centred approach with regular follow-up may be most beneficial due to the complexity of sarcopenia in CKD. Long-term randomized control trials are needed to verify optimal RE prescription and explore safety and efficacy of other nutritional interventions in CKD

Critical Thinking in a College of Business Administration

Phyllis R. Anderson, MetE, MBA, PhD, is a senior university lecturer in the College of Business and Public Administration at Governors State University, One University Parkway, University Park, IL 60484. Joanne R. Reid, BA, MSED, EdD, is the vice president of Corporate Development Associates, Inc., Lombard, IL 60148

Critical Thinking Advances the Theory and Practice of Business Management

A pedagogical treatment was developed to teach critical thinking knowledge, skills, and strategies to college students. This treatment was implemented at a Midwestern University for a three-year period. Graduates were surveyed to determine the extent to which the treatment affected their personal, academic, and professional lives. Graduates reported that they had transferred the critical thinking knowledge, skills, and strategies they had acquired into their personal, academic, and professional lives. This transfer was validated using qualitative descriptions provided by the graduates of their use of critical thinking

Non‐steroidal anti‐inflammatory drugs for treatment of cancer cachexia: A systematic review

Cancer cachexia (CC) is a multifactorial syndrome driven by inflammation, defined by ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support. CC leads to progressive functional impairment, with its clinical management complicated and limited therapeutic options available. The objective of this review was to assess the efficacy and safety of non‐steroidal anti‐inflammatory drugs (NSAIDs) on patient‐centred outcomes in patients with CC. In 2013, two systematic reviews concluded that there was insufficient evidence to recommend NSAIDs for clinical management of CC outside of clinical trials. However, clinical trials of multi‐component CC interventions have included NSAIDs as an intervention component, so an up‐to‐date assessment of the evidence for NSAIDs in the treatment of CC is warranted. Four databases (MEDLINE, EMBASE, CENTRAL and CINAHL) and three trial registers (clinicaltrials.gov, WHO ICTRP and ISRCTN) were searched on 16 December 2022. Randomized controlled trials (RCTs) comparing any NSAID (any dose or duration) with a control arm, in adult patients with CC, reporting measures of body weight, body composition, nutrition impact symptoms, inflammation, physical function or fatigue, were eligible for inclusion. Primary outcomes (determined with patient involvement) were survival, changes in muscle strength, body composition, body weight and quality of life. Included studies were assessed for risk of bias using the Revised Cochrane risk‐of‐bias tool for randomized trials. Five studies were included, which investigated Indomethacin (n = 1), Ibuprofen (n = 1) and Celecoxib (n = 3). Four studies were judged to be at high risk of bias for all outcomes, with one study raising concerns for most outcomes. Considerable clinical and methodological heterogeneity amongst the studies meant that meta‐analysis was not appropriate. There was insufficient evidence to determine whether Indomethacin or Ibuprofen is effective or safe for use in patients with CC; RCTs with lower risk of bias are needed. Celecoxib studies indicated it was safe for use in this population at the doses tested (200–400 mg/day) but found contrasting results regarding efficacy, potentially reflecting heterogeneity amongst the studies. There is inadequate evidence to recommend any NSAID for CC. While current clinical trials for CC treatments are shifting towards multi‐component interventions, further research to determine the efficacy and safety of NSAIDs alone is necessary if they are to be included in such multi‐component interventions. Furthermore, the lack of data on patient‐determined primary outcomes in this review highlights the need for patient involvement in clinical trials for C

Investigating the long-term effects of air pollution on soil properties in the vicinity of the Arnot power station

A study was conducted in 2006 to investigate the long-term effects of air pollution on soil properties in the vicinity of the Arnot power station, Mpumalanga, South Africa. Fifteen sites were re-sampled and the soil chemical properties compared to baseline data gathered in 1996, resulting in a ten year period after which changes in soil properties were investigated. A spatial gradient was incorporated into the study in order to better understand the deposition of pollutants with increasing distance from the power station. The study indicates that long-term acidic deposition has led to detectable changes in soil chemical properties. Three chemical properties, namely the concentrations of calcium and magnesium in both the topsoils and the subsoils, as well as the effective cation exchange capacity in the subsoils showed a significant increase since 1996. However, five soil chemical properties, namely soil pH (K2SO4), the concentration of hydrogen and aluminium and total sulphur in both the topsoils and the subsoils, as well as extractable sulphate in the topsoils and soluble sulphate in the subsoils, all show that the soils have become more acidic over the ten years. The acidic components in the soil override the basic components, as shown by the ratio of basic cations to acidic cations in the soils. The spatial gradient generally indicates that at approximately 8 km from the power station, there is a decrease in the concentration of acidic soil properties and one explanation for this may be a reduction in the acidic components of atmospheric deposition at this site. However, this needs further investigation. Two significant relationships with distance were found, namely a significant negative relationship with soluble sulphate and a significant positive relationship with acid neutralising capacity. This research will form part of a database for other long-term monitoring programmes and will allow data to be compared to other data from this area of research. It will also provide information to important industry leaders such as Eskom

The Experience of Being a Collaborative Writer

This qualitative self-study narrated and analyzed my experience of writing an academic textbook collaboratively with 2 other authors. Social constructivist theory and the idea of cognitive apprenticeship provided a conceptual framework. In this study, I compared my experience with the benefits, challenges, and relational dynamics reported in the literature. Data included face-to-face interviews, recorded Skype conversations, emails, and journal entries. Strategies that can enhance collaborative writing are presented. The study concludes with a discussion of the ways collaborative writing disrupts traditional cultural and academic notions of writing

The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision

BACKGROUND: The concerns of undergraduate nursing and medical students’ regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care. METHODS: A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom. RESULTS: The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care (p < 0.001). CONCLUSIONS: Active, experiential learning in the form of simulation teaching helps improve attitudes of undergraduate nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care