Winter cancellations of elective surgical procedures in the United Kingdom: A questionnaire survey of patients on the economic and psychological impact

Objectives: To quantify the economic and psychological impact of the cancellation of operations due to winter pressures on patients, their families and the economy.Design: This questionnaire study was designed with the help of patient groups. Data were collected on the economic and financial burden of cancellations. Emotions were also quantified on a 5-point Likert scale.Setting: Five NHS Hospital Trusts in the East Midlands region of England.Participants: We identified 796 participants who had their elective operations cancelled between 1 November 2017 and 31 March 2018 and received responses from 339 (43%) participants.Interventions: Participants were posted a modified version of a validated quality of life questionnaire with a prepaid return envelope.Main outcome measures: The primary outcome measures were the financial and psychological impact of the cancellation of elective surgery on patients and their families.Results: Of the 339 respondents, 163 (48%) were age

Short-term, equipment-free high intensity interval training elicits significant improvements in the cardiorespiratory fitness of young adults irrespective of supervision

Introduction:Serious health implications from having low levels of cardiorespiratory fitness (CRF) and/or being overweight in young adulthood are carried forward into later life. High-intensity interval training (HIIT) is a time-effective, potent stimulus for improving CRF and indices of cardiometabolic health. To date, few studies have investigated the use of equipment-free HIIT or the impact of supervision for improving CRF via HIIT.Methods:Thirty healthy young adults (18-30 y) were randomised to 4 weeks equipment-free supervised HIIT (L-HIIT), unsupervised HIIT (H-HIIT) or no-intervention (CON). Measurements of CRF (anaerobic threshold (AT) and VO2peak (VO2)), blood pressure (BP), body mass index (BMI), blood glucose, plasma insulin and muscle architecture were performed at baseline and after the intervention.Results:Both HIIT protocols improved CRF (AT: L-HIIT mean difference (MD) +2.1 (95% CI: 0.34 to 4.03) ml/kg/min; p=0.02; H-HIIT MD +3.01 (1.17 to 4.85) ml/kg/min; p=0.002), VO2: L-HIIT MD +2.94 (0.64 to 5.25) ml/kg/min; p=0.01; H-HIIT MD +2.55 (0.34 to 4.76) ml/kg/min; p=0.03), BMI (L-HIIT MD 0.18 (-0.35 to 0.5) kg/m2; p=0.04; H-HIIT: MD 0.19 (-0.25 to 0.63) kg/m2; p=0.03) and m. vastus lateralis pennation angle (L-HIIT MD 0.2 (0.13 to 0.27)º; p[less than]0.001; H-HIIT MD 0.17 (0.09 to 0.24)º; p[less than]0.001). There was no significant change in BP, glucose or insulin in any of the groups.Conclusions:Four weeks’ time-efficient, equipment-free, bodyweight-based HIIT ais able to elicit improvements in CRF irrespective of supervision status. Unsupervised HIIT may be a useful tool for counteracting the rise of sedentary behaviours and consequent cardiometabolic disorders in young adults

Fasting and surgery timing (FaST) audit

Background & aimsInternational guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK.MethodsThis prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery.ResultsOf the 343 surgical patients included within the study, 50% (n = 172) were male, 78% (n = 266) had elective surgery and 22% (n = 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n = 250) for food, and 21% (n = 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001.ConclusionsDespite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery

Pharmacological hypogonadism impairs molecular transducers of exercise-induced muscle growth in humans

Background: The relative role of skeletal muscle mechano-transduction in comparison with systemic hormones, such as testosterone (T), in regulating hypertrophic responses to exercise is contentious. We investigated the mechanistic effects of chemical endogenous T depletion adjuvant to 6weeks of resistance exercise training (RET) on muscle mass, function, myogenic regulatory factors, and muscle anabolic signalling in younger men. Methods: Non-hypogonadal men (n=16; 18–30years) were randomized in a double-blinded fashion to receive placebo (P, saline n=8) or the GnRH analogue, Goserelin [Zoladex (Z), 3.6mg, n=8], injections, before 6weeks of supervised whole-body RET. Participants underwent dual-energy X-ray absorptiometry (DXA), ultrasound of m. vastus lateralis (VL), and VL biopsies for assessment of cumulative muscle protein synthesis (MPS), myogenic gene expression, and anabolic signalling pathway responses. Results: Zoladex suppressed endogenous T to within the hypogonadal range and was well tolerated; suppression was associated with blunted fat free mass [Z: 55.4±2.8 to 55.8±3.1kg, P=0.61 vs. P: 55.9±1.7 to 57.4±1.7kg, P=0.006, effect size (ES)=0.31], composite strength (Z: 40±2.3% vs. P: 49.8±3.3%, P=0.03, ES=1.4), and muscle thickness (Z: 2.7±0.4 to 2.69±0.36cm, P>0.99 vs. P: 2.74±0.32 to 2.91±0.32cm, P0.99 vs. P: 1.9 fold, P0.99 vs. P: 4.7 fold, P=0.0005, ES=0.68; myogenin: Z: 1.3 fold, P>0.99 vs. P: 2.7 fold, P=0.002, ES=0.72), RNA/DNA (Z: 0.47±0.03 to 0.53±0.03, P=0.31 vs. P: 0.50±0.01 to 0.64±0.04, P=0.003, ES=0.72), and RNA/ASP (Z: 5.8±0.4 to 6.8±0.5, P>0.99 vs. P: 6.5±0.2 to 8.9±1.1, P=0.008, ES=0.63) ratios, as well as acute RET-induced phosphorylation of growth signalling proteins (e.g. AKTser473: Z: 2.74±0.6, P=0.2 vs. P: 5.5±1.1 fold change, P0.99 vs. P: 3.6±1 fold change, P=0.002, ES=0.53). Both MPS (Z: 1.45±0.11 to 1.50±0.06%·day−1, P=0.99 vs. P: 1.5±0.12 to 2.0±0.15%·day−1, P=0.01, ES=0.97) and (extrapolated) muscle protein breakdown (Z: 93.16±7.8 vs. P: 129.1±13.8g·day−1, P=0.04, ES=0.92) were reduced with hypogonadism result in lower net protein turnover (3.9±1.1 vs. 1.2±1.1g·day−1, P=0.04, ES=0.95). Conclusions: We conclude that endogenous T sufficiency has a central role in the up-regulation of molecular transducers of RET-induced muscle hypertrophy in humans that cannot be overcome by muscle mechano-transduction alone

Exploring the efficacy of novel environmental stimuli to improve cardiorespiratory fitness and muscle health in older adults

The UK population is increasing, and people are living longer than ever before, which has implications for the whole of society. Increasing rates of comorbidity and ill-health associated with age is, and will continue to have, significant socioeconomic consequences when considering the treatment of chronic disease and comorbidity, and their implications for hospitalisation and social care for the older adult. The benefits of regular exercise for older adults have been extensively studied and are known to protect against and even reverse the effects of comorbidity. However, rates of exercise uptake amongst older but also younger adults are poor, with a worrying shift to more sedentary lifestyles in an increasingly technological age. The ageing population has also resulted in a generation of comorbid older adults for whom exercise is not possible and as such are prone to muscle wasting. In addition, low cardiorespiratory fitness, which results from prolonged inactivity, is also a risk factor for many cardiovascular and cardiometabolic diseases, and even premature mortality. Higher-intensity exercise interventions with reduced time commitment have been shown to dramatically improve cardiorespiratory fitness and cardiometabolic health in a short timeframe and as such may be more effective in maintaining adherence to regular exercise. However, the health benefits of such regimens have not been extensively studied outside of a supervised, laboratory environment or without utilising expensive gym equipment. This thesis will explore the efficacy of a home-based, high intensity exercise regimen for improving indices of cardiorespiratory fitness in older and younger adults. It shall also explore the effects of supervision on achieving these improvements. Finally, for those who cannot exercise due to older age or co-morbidity, the effects of plant-based treatments on improving blood flow to increase muscle nutrient and oxygen delivery will also be explored

Exploring the efficacy of novel environmental stimuli to improve cardiorespiratory fitness and muscle health in older adults

The UK population is increasing, and people are living longer than ever before, which has implications for the whole of society. Increasing rates of comorbidity and ill-health associated with age is, and will continue to have, significant socioeconomic consequences when considering the treatment of chronic disease and comorbidity, and their implications for hospitalisation and social care for the older adult. The benefits of regular exercise for older adults have been extensively studied and are known to protect against and even reverse the effects of comorbidity. However, rates of exercise uptake amongst older but also younger adults are poor, with a worrying shift to more sedentary lifestyles in an increasingly technological age. The ageing population has also resulted in a generation of comorbid older adults for whom exercise is not possible and as such are prone to muscle wasting. In addition, low cardiorespiratory fitness, which results from prolonged inactivity, is also a risk factor for many cardiovascular and cardiometabolic diseases, and even premature mortality. Higher-intensity exercise interventions with reduced time commitment have been shown to dramatically improve cardiorespiratory fitness and cardiometabolic health in a short timeframe and as such may be more effective in maintaining adherence to regular exercise. However, the health benefits of such regimens have not been extensively studied outside of a supervised, laboratory environment or without utilising expensive gym equipment. This thesis will explore the efficacy of a home-based, high intensity exercise regimen for improving indices of cardiorespiratory fitness in older and younger adults. It shall also explore the effects of supervision on achieving these improvements. Finally, for those who cannot exercise due to older age or co-morbidity, the effects of plant-based treatments on improving blood flow to increase muscle nutrient and oxygen delivery will also be explored

Robotic colorectal surgery: previous laparoscopic colorectal experience is not essential

A background in minimally invasive colorectal surgery (MICS) has been thought to be essential prior to robotic-assisted colorectal surgery (RACS). Our aim was to determine whether MICS is essential prior to starting RACS training based on results from our initial experience with RACS. Two surgeons from our centre received robotic training through the European Academy of Robotic Colorectal Surgery (EARCS). One surgeon had no prior formal MICS training. We reviewed the first 30 consecutive robotic colorectal procedures from a prospectively maintained database between November 2014 and January 2016 at our institution. Fourteen patients were male. Median age was 64.5 years (range 36–82) and BMI was 27.5 (range 20–32.5). Twelve procedures (40%) were performed by the non-MICS-trained surgeon: ten high anterior resections (one conversion), one low anterior resection and one abdomino-perineal resection of rectum (APER). The MICS-trained surgeon performed nine high and four low anterior resections, one APER and in addition three right hemicolectomies and one abdominal suture rectopexy. There were no intra-operative complications and two patients required re-operation. Median post-operative stay was five days (range 1–26). There were two 30-day re-admissions. All oncological resections had clear margins and median node harvest was 18 (range 9–39). Our case series demonstrates that a background in MICS is not essential prior to starting RACS training. Not having prior MICS training should not discourage surgeons from considering applying for a robotic training programme. Safe and successful robotic colorectal services can be established after completing a formal structured robotic training programme

Curcumin Enhances Fed-State Muscle Microvascular Perfusion but Not Leg Glucose Uptake in Older Adults

Therapeutic interventions aimed at enhancing blood flow may combat the postprandial vascular and metabolic dysfunction that manifests with chronological ageing. We compared the effects of acute curcumin (1000 mg) coupled with an oral nutritional supplement (ONS, 7.5 g protein, 24 g carbohydrate and 6 g fat) versus a placebo and ONS (control) on cerebral and leg macrovascular blood flow, leg muscle microvascular blood flow, brachial artery endothelial function, and leg insulin and glucose responses in healthy older adults (n = 12, 50% male, 73 &plusmn; 1 year). Curcumin enhanced m. tibialis anterior microvascular blood volume (MBV) at 180 and 240 min following the ONS (baseline: 1.0 vs. 180 min: 1.08 &plusmn; 0.02, p = 0.01 vs. 240 min: 1.08 &plusmn; 0.03, p = 0.01), and MBV was significantly higher compared with the control at both time points (p &lt; 0.05). MBV increased from baseline in the m. vastus lateralis at 240 min after the ONS in both groups (p &lt; 0.05), and there were no significant differences between groups. Following the ONS, leg blood flow and leg vascular conductance increased, and leg vascular resistance decreased similarly in both conditions (p &lt; 0.05). Brachial artery flow-mediated dilation and middle cerebral artery blood flow were unchanged in both conditions (p &gt; 0.05). Similarly, the curcumin and control groups demonstrated comparable increases in glucose uptake and insulin in response to the ONS. Thus, acute curcumin supplementation enhanced ONS-induced increases in m. tibialis anterior MBV without potentiating m. vastus lateralis MBV, muscle glucose uptake, or systemic endothelial or macrovascular function in healthy older adults

Green Tea Extract Concurrent with an Oral Nutritional Supplement Acutely Enhances Muscle Microvascular Blood Flow without Altering Leg Glucose Uptake in Healthy Older Adults

Postprandial macro- and microvascular blood flow and metabolic dysfunction manifest with advancing age, so vascular transmuting interventions are desirable. In this randomised, single-blind, placebo-controlled, crossover trial, we investigated the impact of the acute administration of green tea extract (GTE; containing ~500 mg epigallocatechin-3-gallate) versus placebo (CON), alongside an oral nutritional supplement (ONS), on muscle macro- and microvascular, cerebral macrovascular (via ultrasound) and leg glucose/insulin metabolic responses (via arterialised/venous blood samples) in twelve healthy older adults (42% male, 74 ± 1 y). GTE increased m. vastus lateralis microvascular blood volume (MBV) at 180 and 240 min after ONS (baseline: 1.0 vs. 180 min: 1.11 ± 0.02 vs. 240 min: 1.08 ± 0.04, both p p m. tibialis anterior perfusion (p > 0.05). Leg blood flow and vascular conductance increased, and vascular resistance decreased similarly in both conditions (p p > 0.05). Glucose uptake increased with the GTE only (0 min: 0.03 ± 0.01 vs. 35 min: 0.11 ± 0.02 mmol/min/leg, p = 0.007); however, glucose area under the curve and insulin kinetics were similar between conditions (p > 0.05). Acute GTE supplementation enhances MBV beyond the effects of an oral mixed meal, but this improved perfusion does not translate to increased leg muscle glucose uptake in healthy older adults