RESUMO
Within the domain of coach education researchers have long called for a paradigm shift, whereby the quality of coaching practice is no longer measured against a checklist of prescribed competencies. This desire to evolve coach education and development, has been aligned to the need to better identify, understand and utilise what adaptive skill and expertise looks, sounds and feels like across specific sport coaching contexts. This paper outlines a broader research plan for the Premier League to drive the progress of research informed practice, in turn shaping a coach development agenda focused on developing adaptive and skilful coaches within Academies. In turn, this is a core feature of the Premier Leagues institutional aim of developing the most skilful coaches in the world. However, in order to begin the process of initiating such a shift in the way things work, there is a need to seek first to understand, before being understood. Therefore, to demonstrate an evidence informed basis to this shift within coach education and development, we ask three questions; (1) Do we understand what the coaches with the highest level of expertise can do? (2) How should we identify coaches with expertise across different contexts? (3) What does coaching expertise research need to do? In answer to these questions, we present the lack of empirical investigation previously conducted in the sports coaching discipline to explore coaching expertise and draw on wider domains to offer possible capacities of skilful coaches who possess expertise. To identify coaches with expertise, coherent with the broader expertise literature, we suggest that this is best conducted via means of social validation. Finally, we offer a road map of investigation designed to explore expertise, formed of a mix of evidence informed methodologies which have not yet been utilised in sport coaching research.
RESUMO
Ventilator-associated pneumonia is the most common healthcare-associated infection in mechanically ventilated patients. Despite this, accurate diagnosis of ventilator-associated pneumonia is difficult owing to the variety of criteria that exist. In this prospective national audit, we aim to quantify the existence of patients with suspected ventilator-associated pneumonia that would not be detected by our standard healthcare-associated infection screening process. Furthermore, we aim to assess the impact of tracheostomy insertion, subglottic drainage endotracheal tubes and chlorhexidine gel on ventilator-associated pneumonia rate. Of the 227 patients recruited, suspected ventilator-associated pneumonia occurred in 32 of these patients. Using the HELICS definition, 13/32 (40.6%) patients were diagnosed with ventilator-associated pneumonia (H-posVAP). Suspected ventilator-associated pneumonia rate was increased in our tracheostomy population, decreased in the subglottic drainage endotracheal tube group and unchanged in the chlorhexidine group. The diagnosis of ventilator-associated pneumonia remains a contentious issue. The formalisation of the HELICS criteria by the European CDC should allow standardised data collection throughout Europe, which will enable more consistent data collection and meaningful data comparison in the future. Our data add weight to the argument against routine oral chlorhexidine. The use of subglottic drainage endotracheal tubes in preventing ventilator-associated pneumonia is interesting and requires further investigation.
RESUMO
OBJECTIVES: The microvascular benefits of regional diets appear in the literature; however, little is known about Nordic-type diets. We investigated the effects of a short-term, adapted, Nordic diet on microvascular function in younger and older individuals at rest and during activity. METHODS: Thirteen young (mean age: 28 y; standard deviation: 5 y) and 15 older (mean age: 68 y; standard deviation: 6 y) participants consumed a modified Nordic diet for 4 wk. Laser Doppler flowmetry and transcutaneous oxygen monitoring were used to assess cutaneous microvascular function and oxygen tension pre- and postintervention; blood pressure, body mass, body fat percentage, ratings of perceived exertion, and peak heart rate during activity were examined concurrently. RESULTS: Axon-mediated vasodilation improved in older participants (1.17 [0.30] to 1.30 [0.30]; P < 0.05). Improvements in endothelium-dependent vasodilation were noted in both young (1.67 [0.50] to 2.03 [0.62]; P < 0.05) and older participants (1.49 [0.37] to 1.63 [0.39]; P < 0.05). Reduced peak heart rate during activity was noted in older participants only (36.5 [8.9] to 35.3 [8.5]; P < 0.05) and reduced body fat percentage in young participants only (young = 27.2 [8.3] to 25.2 [8.8]; P < 0.05). No other variables reached statistical significance; however, trends were observed. CONCLUSIONS: We observed statistically significant improvements in microvascular function, peak heart rate, and body composition. An adapted Nordic diet might improve microvascular health.