Relationship between strength qualities and short track speed skating performance in young athletes.

This study analyzed the relationships between isometric as well as concentric maximum voluntary contraction (MVC) strength of the leg muscles and the times as well as speeds over different distances in 17 young short track speed skaters. Isometric as well as concentric single-joint MVC strength and multi-joint MVC strength in a stable (without skates) and unstable (with skates) condition were tested. Furthermore, time during maximum skating performances on ice was measured. Results indicate that maximum torques during eversion and dorsal flexion have a significant influence on skating speed. Concentric MVC strength of the knee extensors was higher correlated with times as well as speeds over the different distances than isometric MVC strength. Multi-joint MVC testing revealed that the force loss between measurements without and with skates amounts to 25%, while biceps femoris and soleus showed decreased muscle activity and peroneus longus, tibialis anterior, as well as rectus femoris exhibited increased muscle activity. The results of this study depict evidence that the skating times and speeds are primarily influenced by concentric MVC strength of the leg extensors. To be able to transfer the strength onto ice in an optimal way, it is necessary to stabilize the knee and ankle joints.

Control over spinal nociception as quantified by the nociceptive flexor reflex (RIII reflex) can be achieved under feedback of the RIII reflex.

BACKGROUND: Descending pain modulatory systems control transmission of nociceptive information at the spinal level, and their activity can be modified by cognitive and emotional processes. Thus, it may be possible to learn using cognitive-emotional strategies to specifically target descending pathways in order to achieve pain reduction. METHODS: The present study used visual feedback of the nociceptive flexor reflex (RIII reflex) to train healthy subjects over three sessions to reduce their spinal nociception (RIII reflex size) by self-selected cognitive-emotional strategies. The study included two feedback groups (fixed vs. random stimulation intervals) and a control group without feedback (15 subjects each). RESULTS: While all three groups successfully reduced their RIII reflexes (p < 0.01), reductions were larger in the feedback groups (p < 0.05). Success increased over training sessions in the feedback groups (p < 0.05). In the third session, RIII was reduced to 90 ± 15% of baseline in the control group, and to 72 ± 24 and 66 ± 22% in the feedback groups. Most subjects used mental imagery or relaxation to achieve RIII reduction. Pain reduction correlated with RIII reduction in the feedback groups, but was not significantly different between feedback and control groups. CONCLUSIONS: The present results suggest that healthy subjects are able to learn using cognitive and emotional strategies to reduce their spinal nociception under feedback of their RIII reflex size. However, future studies will have to include a sham feedback group to differentiate true learning effects from expectancy effects induced by the feedback procedure.

[Nursing tasks left undone in German acute care hospitals - results from the international study RN4Cast]. / Implizite Rationierung von Pflegeleistungen in deutschen Akutkrankenhäusern - Ergebnisse der internationalen Pflegestudie RN4Cast.

BACKGROUND: Implicit rationing of nursing care - likewise as in medical care - has never been empirically measured in German hospitals. Thus, little is known about prevalence and patterns of nursing care left undone as well as its association with nurse work environment and staffing. METHODOLOGY: We surveyed 1,511 registered nurses from 49 German acute hospitals participating in the multi-country cross-sectional study RN4CAST. Analyses were made by descriptive statistics as well as multilevel regression analysis to calculate predictors from the nurse work environment and staffing. RESULTS: On average 4.7 out of 13 nursing tasks were rationed. The range was between 82% for "comfort/talk with patients" and 15% for "treatments and procedures". The analysis revealed that hospital work environments and staffing ratios were significantly associated with the level of nursing care left undone. Further significant associations were found between poor leadership, inadequate organisation of nursing work as well as high emotional exhaustion and rationing. DISCUSSION: The phenomenon of nursing care left undone was prevalent in German hospitals. Those tasks which are most likely to have negative consequences for patients (e. g., pain management and medication on time) seem to receive higher priority than tasks whose potential effects are less immediate or direct (e. g., psychosocial care). With regard to the measured correlation with the nurse work environment, it is recommend to invest in a good environment before (or simultaneously) investing in nurse staffing.

[Which non-clinical factors influence the use of innovative implants? The example of drug-releasing coronary stents in patients with acute myocardial infarction: a multilevel regression analysis]. / Welche nicht-klinischen Faktoren beeinflussen den Einsatz innovativer Implantate? Das Beispiel medikamentenfreisetzender Koronarstents bei Patienten mit akutem Myokardinfarkt: Eine Mehrebenen-Regressionsanalyse.

BACKGROUND AND PURPOSE: The aim of this paper is to identify characteristics that inhibit or encourage the diffusion of novel implants in the German health care system using the example of drug-eluting stents (DES). After their introduction in the early 2000s, DES were considered as an effective innovative technology. Hypotheses that link the use of DES to characteristics on patient-level, hospital-level, regional-level as well as on state-level are generated on existing literature. These hypotheses are tested using administrative data from a German sickness fund. METHODS: The analysis is based on the administrative sickness fund data of 6 777 patients with a hospital admission due to an acute myocardial infarction (AMI) and an implantation of either a DES or a bare-metal stent. The sickness fund data was merged with information on reimbursement surcharges for DES implantations, information from the German Hospital Registry and information on county level provided by the German National Statistical Office. Logistic regressions with random intercepts on hospital and county level as well as fixed effects on state level were estimated to identify characteristics that are correlated with DES use. RESULTS: All levels do have an impact on the treatment decision whereas the patient-level is of major importance. In particular, young age, admission to a university or a privately owned hospital and a hospital located in a county with a low level of bankruptcies are positively correlated with DES use. CONCLUSION: Although individual characteristics are of major importance for DES use in the German health care system, characteristics at the hospital and regional level do have an impact on the use of DES. Further research on the influence of reimbursement mechanisms in the German setting is needed.

Accuracy of prenatal three-dimensional ultrasound in the diagnosis of cleft hard palate when cleft lip is present.

OBJECTIVE: To investigate the accuracy of prenatal axial three-dimensional (3D) ultrasound in predicting the absence or presence of cleft palate in the presence of cleft lip. METHODS: Between March 2005 and January 2009, there were 81 cases with a prenatal two-dimensional (2D) ultrasound screening diagnosis of unilateral or bilateral cleft lip at 22-25 weeks of gestation referred to our tertiary care center. Of these, 79 fetuses were included in this prospective study and two were excluded. Axial 3D ultrasound imaging of the fetal palate was performed and the diagnoses were compared with clinical findings at delivery. The frequencies of intact and cleft palate, the degree of association between the prenatal predictions and postnatal findings and the probability of detection of cleft lip and palate were determined. RESULTS: Of 79 prenatal predictions, 77 (97%) were correct and the association between the prenatal predictions and postnatal findings was strong. The sensitivity for detection of cleft lip and palate within this high-risk population was 100% and the specificity was 90%. In one of the excluded cases, the palate could not be visualized due to a fetal prone position. There were chromosomal anomalies in 4% of cases and associated structural or growth anomalies in 23%, termination of pregnancy was carried out in 4% and intrauterine fetal demise occurred in 3%. CONCLUSION: Axial 3D ultrasound of the fetal palate has high accuracy in identifying prenatal cleft palate when cleft lip is diagnosed at mid-trimester 2D ultrasound screening.

Prenatal assessment of the normal fetal soft palate by three-dimensional ultrasound examination: is there an objective technique?

OBJECTIVES: To describe a three-dimensional (3D) ultrasound technique for assessing the fetal soft palate. METHODS: A prospective study conducted from April to December 2006 included 87 fetuses in a low-risk population. Fetal ultrasound scans were performed between 21 and 25 weeks of gestation to determine the normal 3D ultrasound view of the fetal soft tissues of the palate. The sonographers used a 30 degrees-inclined axial 3D view of the fetal palate. Ultrasound images obtained in this view were compared with fetopathological specimens of the same gestational age by two observers, both pediatric surgeons. Each observer indicated whether they thought that the uvula or the velum could be detected, and the differences in responses between the observers were assessed. RESULTS: The frequencies of detection of the uvula and velum of each observer varied between 80% and 90%. The observers showed a significant difference in judging the visualization of the uvula, but not in judging the velum. CONCLUSIONS: A 30 degrees -inclined axial 3D ultrasound view seems to be effective in assessing the integrity of the fetal soft palate.

Sonographic assessment of normal fetal palate using three-dimensional imaging: a new technique.

OBJECTIVES: The aim of this study was to describe a novel three-dimensional (3D) ultrasound rendering technique to examine the normal fetal posterior palate and to assess its correspondence with the real fetal anatomy. METHODS: A prospective longitudinal study was conducted from January to October 2005 and included 100 fetuses in a low-risk population. Fetal ultrasound examinations were performed at 17, 22, 27 and 32 weeks' gestation to determine the normal 3D ultrasound view of the fetal palate at different gestational ages. The ultrasound scans were performed using the strict anterior axial plane of the starting reconstruction volume and the underside 3D view of the fetal palate. The 3D view of the fetal palate was compared with the normal anatomical view of the fetal palate obtained by surgical fetopathological examination of fetuses at the same gestational ages. The sonographic visualization rates of seven defined anatomical landmarks of the fetal palate were computed for each gestational age. The visualization rates across gestational ages were compared by use of the Cochrane Q test. The reliability of detection of each anatomical landmark across gestational ages was determined by Cronbach's Alpha. RESULTS: In all cases a 3D ultrasound view of the fetal maxilla and secondary palate was obtained at each period of gestation and corresponded well to the fetal anatomical specimens. The seven defined anatomical landmarks of the fetal palate were identified in 42-100% of cases. The visualization rates across gestational ages were significantly different in five of these anatomical landmarks. These differences can be explained by different developmental processes of these anatomical structures. The overall reliability of visualization across the gestational ages for the anatomical landmarks was medium to very high (0.73-0.96), except for the landmark interpalatal suture which was low (0.48). CONCLUSIONS: This technique of anterior axial 3D view reconstruction of the fetal palate seen by an underside view can provide unique diagnostic information on the integrity of the secondary palate. This innovative, simple and rapid technique may become the reference technique in ultrasound investigation of the fetal palate, and should be of value in diagnosing isolated secondary cleft palate or palatal involvement when cleft lip and alveolus are diagnosed.