Delirium in hospitalized older people is common and has a varied presentation and time course. Clinicians and researchers need to consider this great heterogeneity when caring for patients and when studying delirium.
This study demonstrates that reliance on nutritional supplements increases as adolescents mature. The apparent willingness of adolescents to use a supplement that may harm their health or shorten their life highlights the need for greater involvement of teachers, coaches, and physicians to provide continued education on the risks and benefits associated with nutritional supplementation and AS use.
The purpose of this study was to examine the efficacy of periodization and to compare different periodization models in resistance trained American football players. Fifty-one experienced resistance trained American football players of an NCAA Division III football team (after 10 weeks of active rest) were randomly assigned to 1 of 3 groups that differed only in the manipulation of the intensity and volume of training during a 15-week offseason resistance training program. Group 1 participated in a nonperiodized (NP) training program, group 2 participated in a traditional periodized linear (PL) training program, and group 3 participated in a planned nonlinear periodized (PNL) training program. Strength and power testing occurred before training (PRE), after 7 weeks of training (MID), and at the end of the training program (POST). Significant increases in maximal (1-repetition maximum [1RM]) squat, 1RM bench press, and vertical jump were observed from PRE to MID for all groups; these increases were still significantly greater at POST; however, no MID to POST changes were seen. Significant PRE to POST improvements in the medicine ball throw (MBT) were seen for PL group only. The results do not provide a clear indication as to the most effective training program for strength and power enhancements in already trained football players. Interestingly, recovery of training-related performances was achieved after only 7 weeks of training, yet further gains were not observed. These data indicate that longer periods of training may be needed after a long-term active recovery period and that active recovery may need to be dramatically shortened to better optimize strength and power in previously trained football players.
The effect of 30 days of beta-alanine supplementation (4.8 g per day) on resistance exercise performance and endocrine changes was examined in eight experienced resistance-trained men. An acute resistance exercise protocol consisting of 6 sets of 12 repetitions of the squat exercise at 70 % of one-repetition maximum (1-RM) with 1.5 minutes of rest between sets was performed before and after each supplemental period. Blood draws occurred at baseline (BL), immediate (IP), 15-minutes (15P) and 30-minutes (30P) postexercise for growth hormone, testosterone and cortisol concentrations. A 22 % (p < 0.05) difference in total number of repetitions performed at the end of 4 weeks of supplementation was seen between beta-alanine (BA) and placebo (PL), and Delta mean power was greater in BA (98.4 +/- 43.8 w) vs. PL (7.2 +/- 29.6 w). Growth hormone concentrations were elevated from BL at IP and 15P for both groups, while cortisol concentrations were greater than BL at all time points for both BA and PL. No group differences were noted. No change from BL was seen in testosterone concentrations for either group. Results indicate that four weeks of beta-alanine supplementation can significantly improve muscular endurance during resistance training in experienced resistance-trained athletes. However, these performance gains did not affect the acute endocrine response to the exercise stimulus.
The effect of a pre-exercise energy sport drink on the acute hormonal response to resistance exercise was examined in eight experienced resistance trained men. Subjects were randomly provided either a placebo (P: maltodextrin) or the supplement (S: combination of branched chain amino acids, creatine, taurine, caffeine, and glucuronolactone). Subjects performed 6 sets of no more than 10 repetitions of the squat exercise at 75% of their 1 repetition maximum (1RM) with 2 minutes of rest between sets. Blood draws occurred at baseline pre-exercise, immediately post-(IP), 15 minutes post-(15P), and 30-minutes post (30P) exercise for measurement of serum growth hormone, total and free testosterone, cortisol, and insulin concentrations. Although significant differences were seen only at set 5, the total number of repetitions and training volume tended (p = 0.08) to be higher with S compared to P. Serum growth hormone and insulin concentrations were significantly higher at 15P and IP, respectively, in S compared to P. Results suggest that a pre-exercise energy S consumed 10 minutes before resistance exercise can enhance acute exercise performance by increasing the number of repetitions performed and the total volume of exercise. The enhanced exercise performance resulted in a significantly greater increase in both growth hormone and insulin concentrations, indicating an augmented anabolic hormone response to this pre-exercise S.
PURPOSE The goal of this study was to develop a technology-based strategy to identify patients with undiagnosed hypertension in 23 primary care practices and integrate this innovation into a continuous quality improvement initiative in a large, integrated health system.
METHODSIn phase 1, we reviewed electronic health records (EHRs) using algorithms designed to identify patients at risk for undiagnosed hypertension. We then invited each at-risk patient to complete an automated office blood pressure (AOBP) protocol. In phase 2, we instituted a quality improvement process that included regular physician feedback and office-based computer alerts to evaluate at-risk patients not screened in phase 1. Study patients were observed for 24 additional months to determine rates of diagnostic resolution.
RESULTSOf the 1,432 patients targeted for inclusion in the study, 475 completed the AOBP protocol during the 6 months of phase 1. Of the 1,033 at-risk patients who remained active during phase 2, 740 (72%) were classified by the end of the follow-up period: 361 had hypertension diagnosed, 290 had either white-coat hypertension, prehypertension, or elevated blood pressure diagnosed, and 89 had normal blood pressure. By the end of the follow-up period, 293 patients (28%) had not been classified and remained at risk for undiagnosed hypertension.CONCLUSIONS Our technology-based innovation identified a large number of patients at risk for undiagnosed hypertension and successfully classified the majority, including many with hypertension. This innovation has been implemented as an ongoing quality improvement initiative in our medical group and continues to improve the accuracy of diagnosis of hypertension among primary care patients.
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