BackgroundEvidence is limited for the effectiveness of interventions for survivors of critical illness after hospital discharge. We explored the effect of an 8-week hospital-based exercise-training programme on physical fitness and quality-of-life.MethodsIn a parallel-group minimized controlled trial, patients were recruited before hospital discharge or in the intensive care follow-up clinic and enrolled 8–16 weeks after discharge. Each week, the intervention comprised two sessions of physiotherapist-led cycle ergometer exercise (30 min, moderate intensity) plus one equivalent unsupervised exercise session. The control group received usual care. The primary outcomes were the anaerobic threshold (in ml O2 kg−1 min−1) and physical function and mental health (SF-36 questionnaire v.2), measured at Weeks 9 (primary time point) and 26. Outcome assessors were blinded to group assignment.ResultsThirty patients were allocated to the control and 29 to the intervention. For the anaerobic threshold outcome at Week 9, data were available for 17 control vs 13 intervention participants. There was a small benefit (vs control) for the anaerobic threshold of 1.8 (95% confidence interval, 0.4–3.2) ml O2 kg−1 min−1. This advantage was not sustained at Week 26. There was evidence for a possible beneficial effect of the intervention on self-reported physical function at Week 9 (3.4; −1.4 to 8.2 units) and on mental health at Week 26 (4.4; −2.4 to 11.2 units). These potential benefits should be examined robustly in any subsequent definitive trial.ConclusionsThe intervention appeared to accelerate the natural recovery process and seems feasible, but the fitness benefit was only short term.Clinical trial registrationCurrent Controlled Trials ISRCTN65176374 ().
Patients who survive critical illness often report deterioration in health related quality of life. This has not been shown to improve following post-intensive care unit (ICU) self-directed exercise. The Post Intensive Care eXercise (PIX) study demonstrated improved objectively measured fitness following a supervised exercise programme following critical illness and also suggested beneficial effects on physical and mental health. The qualitative arm of the PIX study reported here utilised focus groups to explore in more detail recovery from critical illness, quality of life following hospital discharge, perceptions of the exercise programme and it's impact on perceived well-being. Sixteen participants (eight of whom underwent the supervised exercise programme) were allocated to four psychologist lead focus groups. Themes identified after hospital discharge centred on social isolation, abandonment, vulnerability and reduced physical activity. However, patients in the exercise group described exercise training as motivating, increasing energy levels and sense of achievement, social interaction and confidence. This study adds to the sparse literature on the patient experience post critical illness. It supports the improvements in physical and mental health suggested with exercise in the PIX study and would support further research in relation to the effects of supervised exercise and rehabilitation programmes post critical illness. It recommends that future comparative outcome studies in this patient population also include interview-based assessment as part of assessment of quality of life and an individual's functional status.
The two main methods of managing head lice infestation in the UK are head lice lotions and bug busting; there is no conclusive evidence as to which of these methods is most effective. The aim of this study was to compare the effectiveness of the bug busting method with lotion. A pilot study in the form of a randomized controlled trial involving two semi-rural general practices was used. Thirty children aged 4-16 years were randomly assigned to two intervention groups. After initial dry combing to detect the presence of head lice, one group was treated with phenothrin lotion. The bug busting group received combing using special combs provided in the bug busting pack and hair conditioner. The main outcome measure was the number of adult live lice and nymphs at day 14. On day 14 in the bug busting group, total eradication of head lice had occurred in eight children; in the lotion group, total eradication had occurred in two children (P=0.052); number needed to treat 2.5 (95% CI: 2.19-2.81). These results suggest that bug busting performed by nurses in a controlled situation is an effective method of managing head lice infestation.
Antibiotic prescribing for acute otitis media is common and studies have failed to show signi cant short-term bene ts for their use in the treatment of this condition. Antibiotic resistance is an escalating problem related to antibiotic use and the Department of Health has published guidelines advising that they are probably unnecessary in otitis media. The aims of this study were to primarily explore parents' ideas, concerns and experiences when consulting for otitis media in children. Secondly, to develop strategies that general practitioners can use to improve doctor-patient communication and the doctors' ability to negotiate management options acceptable to patients, taking into consideration current evidence-based guidelines. A qualitative research design using focus groups were employed. The study sample interviewed were parents of children. A total of 17 parents representing a range of ages and different socioeconomic backgrounds attended the focus groups. Six major themes emerged from the analysis. These themes suggested that parents' were given little information and had a poor understanding of ear infections. They expected the general practitioner (GP) to primarily make a diagnosis followed by an explanation and discussion. Parents also wished to be reassured that their child was not suffering from anything more serious, in particular, meningitis. Most were happy not to have antibiotics prescribed and preferred the doctor to make the decision about the use of antibiotics. Parents were happy to consider seeing a practice nurse when their child presented with otitis media. The strategies recommended for general practitioners is to provide a diagnosis and reassure parents about meningitis and other long-term complications and to be aware that they may overestimate parents' expectations of a prescription. General practitioners should also be exible in involving them in the decision making process.
BACKGROUND: Circadian rhythms, and their potential influence on athletic performance, have been the subject of a number of investigations. OBJECTIVE: This study aimed to determine the influence of circadian rhythms on the peak isokinetic force of the quadriceps and hamstring muscle groups, and the relationship of cortisol level with these measures. METHODS: Twelve male and twelve female participants completed maximal isokinetic flexion and extension movements of their dominant leg at 60 • /s using an isokinetic dynamometer. Data were collected at 09.00 (Session A), 14.00 (Session B) and 18.00 (Session C). Salivary cortisol was also obtained immediately prior to each session. Differences in isokinetic strength parameters and salivary cortisol concentrations, between the three sessions, were examined using 2 × 3 mixed ANOVAs. Pearson correlations were used to examine the relationship between isokinetic strength and salivary cortisol. RESULTS: For all of the flexion parameters, but none of their extension counterparts, session C was associated with significantly greater isokinetic strength compared to session A. No significant relationships were observed between measures of isokinetic strength and cortisol. CONCLUSIONS: The findings from this investigation suggest that both male and female athletes performing knee flexion strengthening exercises should conduct their training/competitions in the late afternoon or early evening in order to maximize performance.
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