Objectives: The aims of this study were (1) to quantify and compare the load of a professional football team's training days and matches and (2) to compare training of nonstarters the day after the match with regular training of starters and nonstarters. Methods: On-field training load during in-season training days (categorized as days before match day, i.e., MD minus) and 3 friendly matches were recorded using alocal positioning measurement system. Results: Mixed linear models showed lower load when training approached match day. Relative to match values (100%), training values for running (52 -20%; MD-4 -MD-1) and high-speed running (38 -15%) were lower than for total distance (67 -35%), and all considerably lower than match values. On average, medium and high accelerations and decelerations during training were more similar to match values (90 -39%). Load during nonstarters training was lower than during regular training for almost all variables on MD-4 and several high-intensity variables on MD-3 and MD-2. Conclusions: The results highlight that acceleration and deceleration measures complement more commonly used external load variables based on distance and speed. Furthermore, nonstarters are potentially under-loaded compared to starters, especially in terms of (high-speed) running.

SummaryPostoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X‐rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X‐ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single‐centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X‐ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X‐ray. We compared lung ultrasound with chest X‐ray for the detection of postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications. We also assessed inter‐observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically‐relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X‐ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X‐ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X‐ray 7 out of 17 patients (41%) with clinically‐relevant postoperative pulmonary complications (p < 0.001). The clinically‐relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X‐ray (p = 0.024). Overall inter‐observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically‐relevant postoperative pulmonary complications than chest X‐ray, and at an earlier time‐point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making.

Objective To evaluate whether C reactive protein point-of-care testing (CRP POCT) safely reduces antibiotic prescribing for lower respiratory tract infections in nursing home residents. Design Pragmatic, cluster randomised controlled trial. Setting The UPCARE study included 11 nursing home organisations in the Netherlands. Participants 84 physicians from 11 nursing home organisations included 241 participants with suspected lower respiratory tract infections from September 2018 to the end of March 2020. Interventions Nursing homes allocated to the intervention group had access to CRP POCT. The control group provided usual care without CRP POCT for patients with suspected lower respiratory tract infections. Main outcome measures The primary outcome measure was antibiotic prescribing at initial consultation. Secondary outcome measures were full recovery at three weeks, changes in antibiotic management and additional diagnostics during follow-up at one week and three weeks, and hospital admission and all cause mortality at any point (initial consultation, one week, or three weeks). Results Antibiotics were prescribed at initial consultation for 84 (53.5%) patients in the intervention group and 65 (82.3%) in the control group. Patients in the intervention group had 4.93 higher odds (95% confidence interval 1.91 to 12.73) of not being prescribed antibiotics at initial consultation compared with the control group, irrespective of treating physician and baseline characteristics. The between group difference in antibiotic prescribing at any point from initial consultation to follow-up was 23.6%. Differences in secondary outcomes between the intervention and control groups were 4.4% in full recovery rates at three weeks (86.4% v 90.8%), 2.2% in all cause mortality rates (3.5% v 1.3%), and 0.7% in hospital admission rates (7.2% v 6.5%). The odds of full recovery at three weeks, and the odds of mortality and hospital admission at any point did not significantly differ between groups. Conclusions CRP POCT for suspected lower respiratory tract infection safely reduced antibiotic prescribing compared with usual care in nursing home residents. The findings suggest that implementing CRP POCT in nursing homes might contribute to reduced antibiotic use in this setting and help to combat antibiotic resistance. Trial registration Netherlands Trial Register NL5054

BackgroundUnnecessary long-term use of broad-spectrum antibiotics is linked to the emergence and selection of resistant bacteria, prolonged hospitalisation and increased costs. Several clinical trials indicate that the biomarker procalcitonin (PCT) can guide antibiotic therapy. Some of these trials have shown a promising reduction in the number of antibiotic prescriptions, duration of antibiotic therapy and even length of stay in the ICU, although their size and selection criteria limit their external validity. The objectives of the Stop Antibiotics on guidance of Procalcitonin Study (SAPS) are to evaluate whether daily PCT can improve “real-life” antibiotic use in Dutch ICU’s by reduction of the duration of antibiotic treatment without an increase of recurrent infections and mortality.Methods/DesignMulticenter randomised controlled intervention trial. Powered for superiority of the primary efficacy endpoint and non-inferiority on the primary safety endpoints (non-inferiority margin is set on 8%).Inclusion criteria: (1) ICU-patients aged ≥18 years and (2) receiving antibiotics for a presumed or proven infection and (3) signed informed consent. Exclusion criteria: (1) patients who require prolonged antibiotic therapy, (2) suffer from Mycobacterium tuberculosis, (3) cystic fibrosis, (4) viral or parasitic infections and (5) those that are severely immunocompromised or (6) moribund.The intervention consists solely of an advice to discontinue antibiotic treatment in case PCT has decreased by more than 80% of its peak level (relative stopping threshold) or decrease below a value of 0.5 ng/ml (absolute stopping threshold).The study hypothesis is that PCT-guided therapy is non-inferior to standard care based on implemented guidelines and local expertise, whilst reducing antibiotic usage. Computerised 1:1 randomisation will allocate 908 patients per arm. Arm 1: standard of care. Arm 2: procalcitonin-guided therapy. The primary efficacy endpoint is consumption of antibiotics expressed as the defined daily dosage and duration of antibiotic therapy expressed in days of therapy. This trial is designed to shorten antibiotics safely, therefore the primary safety endpoint is mortality measured at 28 day and 1 year.DiscussionThis will be the largest procalcitonin-guided antibiotic intervention trial in ICU setting thus far. Currently 1600 of the planned 1816 patients are randomised (November 2012). The first interim analysis has passed without any safety or futility issues.Trial registrationTrial registration number at http://www.clinicaltrials.gov: Id. Nr. NCT01139489 , at http://www.trialregister.nl: Id.nr. NTR1861.

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