Effects of Ketone Monoester and Bicarbonate Co-Ingestion on Cycling Performance in WorldTour Cyclists.

The present randomized study investigated the effect of acute supplementation of 800 mg/kg of ketone monoester ingestion (KE) or placebo (PL) and 210 mg/kg of NaHCO3 co-ingestion on cycling performance of WorldTour cyclists during a road cycling stage simulation. Twenty-eight cyclists participated in the study (27.46 ± 4.32 years; 1.80 ± 0.06 m; 69.74 ± 6.36 kg). Performance, physiological, biochemical, and metabolism outcomes, gut discomfort, and effort perceived were assessed during a road cycling simulation composed of an 8-min time-trial (TT) performance + 30-s TT + 4.5 hr of outdoor cycling + a second 8-min TT + a second 30-s TT. Greater absolute and relative mean power during the first 8-min TT (F = 5.067, p = .033, ηp2=.163, F = 5.339, p = .029, ηp2=.170, respectively) was observed after KE than after PL (KE: 389 ± 34, PL: 378 ± 44 W, p = .002, d = 0.294 and KE: 5.60 ± 0.42, PL: 5.41 ± 0.44 W/kg, p = .001, d = 0.442). Additionally, greater concentration of ß-hydroxybutyrate blood concentration (F = 42.195, p < .001, ηp2=.619) was observed after KE than after PL during the first steps of the stage (e.g., after warm-up KE: 1.223 ± 0.642, PL: 0.044 ± 0.058 mM, p < .001, d = 2.589), although the concentrations returned to near baseline after 4.5 hr of outdoor cycling. Moreover, higher values of anion gap were observed (F = 2.333, p = .026, ηp2=.080) after KE than after PL ingestion, after the warm-up and after the first 8-min and 30-s TT. Additionally, lower concentrations of HCO3- were reported in the KE condition after warm-up and after the first 8-min and 30-s TT. During the initial phase of the stage simulation, acute supplementation with KE + NaHCO3 co-ingestion enhanced 8-min TT cycling performance (3.1%) in WorldTour cyclists with a concomitant hyperketonaemia.

[Patient safety in nursing homes. The experience of the Autonomous Community of the Region of Murcia]. / La seguridad del paciente en las residencias sociosanitarias. La experiencia de la Comunidad Autónoma de la Región de Murcia.

The pandemic has exposed the vulnerability of residential centers and the fragility of the population that lives there. In the Region of Murcia, care for this population group became a priority and a regional plan was drawn up to attend the needs of residents from the ethical framework of procedural justice. The immediacy imposed by the health crisis has meant that all this intervention is not without risks. Based on the Reason model, we have carried out a root cause analysis of the contributing factors that led the nursing homes to suffer a devastating impact, categorizing the security failures at three levels: infection control, social health environment and health-clinical environment. The pandemic has shown the urgency of strengthening the care model that we offer to our elders. A model that guarantees the coverage of the needs of extremely fragile patients that go beyond health and biomedical care and that considers their preferences and values.