Is Exercise Prescription in Cardiac Rehabilitation Influenced by Physical Capacity or Cardiac Intervention?

This study investigated the influence of cardiac intervention and physical capacity of individuals attending an Australian outpatient cardiac rehabilitation program on the initial exercise prescription. A total of 85 patients commencing outpatient cardiac rehabilitation at a major metropolitan hospital had their physical capacity assessed by an incremental shuttle walk test, and the initial aerobic exercise intensity and resistance training load prescribed were recorded. Physical capacity was lower in surgical patients than nonsurgical patients. While physical capacity was higher in younger compared with older surgical patients, there was no difference between younger and older nonsurgical patients. The initial exercise intensity did not differ between surgical and nonsurgical patients. This study highlights the importance of preprogram exercise testing to enable exercise prescription to be individualized according to actual physical capacity, rather than symptoms, comorbidities and age, in order to maximize the benefit of cardiac rehabilitation.

Validation of the Ottawa Ankle Rules for Acute Foot and Ankle Injuries.

UNLABELLED: The original and modified Ottawa Ankle Rules (OARs) were developed as clinical decision rules for use in emergency departments. However, the OARs have not been evaluated as an acute clinical evaluation tool. OBJECTIVE: To evaluate the measures of diagnostic accuracy of the OARs in the acute setting. METHODS: The OARs were applied to all appropriate ankle injuries at 2 colleges (athletics and club sports) and 21 high schools. The outcomes of OARs, diagnosis, and decision for referral were collected by the athletic trainers (ATs) at each of the locations. Contingency tables were created for evaluations completed within 1 h for which radiographs were obtained. From these data the sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS: The OARs met the criteria for radiographs in 100 of the 124 cases, of which 38 were actually referred for imaging. Based on radiographic findings in an acute setting, the OARs (n = 38) had a high sensitivity (.88) and are good predictors to rule out the presence of a fracture. Low specificity (0.00) results led to a high number of false positives and low positive predictive values (.18). CONCLUSION: When applied during the first hour after injury the OARs significantly overestimate the need for radiographs. However, a negative finding rules out the need to obtain radiographs. It appears the AT's decision making based on the totality of the examination findings is the best filter in determining referral for radiographs.

Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014.

BACKGROUND: Research on Australian cardiovascular disease secondary prevention and cardiac rehabilitation to guide practice needs updating to reflect current context of practice. It is timely therefore to review the core components that underpin effective services that deliver maximum benefits for participants. METHODS: The Australian Cardiovascular Health and Rehabilitation Association (ACRA) convened an inter-agency, multidisciplinary, nationally representative expert panel of Australia's leading cardiac rehabilitation clinicians, researchers and health advocates who reviewed the research evidence. RESULTS: Five core components for quality delivery and outcomes of services were identified and are recommended: 1) Equity and access to services, 2) Assessment and short-term monitoring, 3) Recovery and longer term maintenance, 4) Lifestyle/behavioural modification and medication adherence, and 5) Evaluation and quality improvement. CONCLUSIONS: ACRA seeks to provide guidance on the latest evidence in cardiovascular disease secondary prevention and cardiac rehabilitation. Clinicians should use these core components to guide effective service delivery and promote high quality evidence based care. Directors of hospitals and health services should use these core components to aid decision-making about the development and maintenance of these services.

Gut microbial ecology of the Critically Endangered Fijian crested iguana (Brachylophus vitiensis): Effects of captivity status and host reintroduction on endogenous microbiomes.

Animals often exhibit distinct microbial communities when maintained in captivity as compared to when in the wild. Such differentiation may be significant in headstart and reintroduction programs where individuals spend some time in captivity before release into native habitats. Using 16S rRNA gene sequencing, we (i) assessed differences in gut microbial communities between captive and wild Fijian crested iguanas (Brachylophus vitiensis) and (ii) resampled gut microbiota in captive iguanas released onto a native island to monitor microbiome restructuring in the wild. We used both cloacal swabs and fecal samples to further increase our understanding of gut microbial ecology in this IUCN Critically Endangered species. We found significant differentiation in gut microbial community composition and structure between captive and wild iguanas in both sampling schemes. Approximately two months postrelease, microbial communities in cloacal samples from formerly captive iguanas closely resembled wild counterparts. Interestingly, microbial communities in fecal samples from these individuals remained significantly distinct from wild conspecifics. Our results indicate that captive upbringings can lead to differences in microbial assemblages in headstart iguanas as compared to wild individuals even after host reintroduction into native conditions. This investigation highlights the necessity of continuous monitoring of reintroduced animals in the wild to ensure successful acclimatization and release.

Rehabilitation After Hip Arthroscopy: A Movement Control-Based Perspective.

Adequate control of movement is essential for patients to return to unrestricted function after hip arthroscopic surgery. Mobility, muscle performance and stability, and neuromuscular control are vital aspects addressed in rehabilitation to help re-establish control of movement for function. Initial joint protection is a hallmark for all patients after hip arthroscopy to prevent intra-articular and extra-articular soft tissue irritation of healing tissues. It is essential to tailor exercises of each phase to patients' specific functional demands. Each phase of rehabilitation should be monitored so that patients are not advanced too quickly, which can lead to setbacks and delays in return to normal function.