Effects of Resisted Sprint Training and Traditional Power Training on Sprint, Jump, and Balance Performance in Healthy Young Adults: A Randomized Controlled Trial.

Power training programs have proved to be effective in improving components of physical fitness such as speed. According to the concept of training specificity, it was postulated that exercises must attempt to closely mimic the demands of the respective activity. When transferring this idea to speed development, the purpose of the present study was to examine the effects of resisted sprint (RST) vs. traditional power training (TPT) on physical fitness in healthy young adults. Thirty-five healthy, physically active adults were randomly assigned to a RST (n = 10, 23 ± 3 years), a TPT (n = 9, 23 ± 3 years), or a passive control group (n = 16, 23 ± 2 years). RST and TPT exercised for 6 weeks with three training sessions/week each lasting 45-60 min. RST comprised frontal and lateral sprint exercises using an expander system with increasing levels of resistance that was attached to a treadmill (h/p/cosmos). TPT included ballistic strength training at 40% of the one-repetition-maximum for the lower limbs (e.g., leg press, knee extensions). Before and after training, sprint (20-m sprint), change-of-direction speed (T-agility test), jump (drop, countermovement jump), and balance performances (Y balance test) were assessed. ANCOVA statistics revealed large main effects of group for 20-m sprint velocity and ground contact time (0.81 ≤ d ≤ 1.00). Post-hoc tests showed higher sprint velocity following RST and TPT (0.69 ≤ d ≤ 0.82) when compared to the control group, but no difference between RST and TPT. Pre-to-post changes amounted to 4.5% for RST [90%CI: (-1.1%;10.1%), d = 1.23] and 2.6% for TPT [90%CI: (0.4%;4.8%), d = 1.59]. Additionally, ground contact times during sprinting were shorter following RST and TPT (0.68 ≤ d ≤ 1.09) compared to the control group, but no difference between RST and TPT. Pre-to-post changes amounted to -6.3% for RST [90%CI: (-11.4%;-1.1%), d = 1.45) and -2.7% for TPT [90%CI: (-4.2%;-1.2%), d = 2.36]. Finally, effects for change-of-direction speed, jump, and balance performance varied from small-to-large. The present findings indicate that 6 weeks of RST and TPT produced similar effects on 20-m sprint performance compared with a passive control in healthy and physically active, young adults. However, no training-related effects were found for change-of-direction speed, jump and balance performance. We conclude that both training regimes can be applied for speed development.

Decision-to-Delivery Time and Perinatal Complications in Emergency Cesarean Section.

BACKGROUND: A decision-to-delivery interval (DDI) of no more than 20 minutes has long been considered a requirement for cesarean sections, even though there have hardly been any studies on this topic. We retrospectively investigated data relevant to DDI for emergency cesarean sections performed for the most common indications, namely, suspected and documented fetal asphyxia. METHODS: We analyzed data on emergency in-hospital cesarean sections in the period 2008-2015. Low 5- and 10-minute Apgar scores (a scheme with points awarded for breathing, heart rate, muscle tone, skin coloration, and the elicitability of reflexes) were the primary endpoints; acid-base status in arterial cord blood and in-hospital neonatal death were the secondary endpoints. The raw analysis was supplemented by an analysis adjusted for various factors including gestational age, maternal age, and obstetrical presentation. RESULTS: Data from 39 291 neonates were included. The DDI was up to 10 minutes in 64.6% of cases, from 11 to 20 minutes in 34.3%, and over 20 minutes in 1.1%. Low Apgar scores were less common in children whose emergency cesarean sections were performed within 10 minutes or within 20 minutes. For example, the adjusted odds ratio for a 10-minute Apgar score below 4 was 0.49 (95% confidence interval [0.25; 0.96] when a DDI of more than 20 minutes was used as the reference criterion. CONCLUSION: This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.

Association between Potentially Inappropriate Medication (PIM) Use and Risk of Hospitalization in Older Adults: An Observational Study Based on Routine Data Comparing PIM Use with Use of PIM Alternatives.

OBJECTIVE: The safety of potentially inappropriate medications (PIMs) in elderly patients is still debated. Using the PRISCUS list, we examined the incident all-cause hospitalization risk associated with PIMs compared to PIM alternatives during the 180 days post individual first pharmacy dispensing (index date). METHODS: Routine claims data from a German health insurer on 392,337 ambulatory patients aged ≥65 years, were used to estimate adjusted hazard ratios (HRs) for hospitalization associated with incident PIM use. Observation period was January 2009 -December 2010. Users of PIM alternatives, as defined by the PRISCUS list, were the reference group. Patients with PIM dispensing or hospital stay in a six month "washout" period (second half of 2008) were excluded. All potential confounders were determined in the half year before the individual index date. RESULTS: In the total cohort 60.7% were female. Median age was 73 years. Of 79,041 incident PIM users, 58.4% had PIMs dispensed in one quarter of 2009 or 2010, 19.3% in two quarters, and 22.3% in three or more quarters. There were 126,535 hospitalizations during the observation period, and 47,470 of them occurred within 180 days post first dispensing. Multivariable Cox regression analysis revealed PIM use as a significant risk factor for hospitalization (HR 1.378; 95% CI 1.349-1.407) compared to use of PIM alternatives. CONCLUSIONS: PIM use compared to use of PIM alternatives is associated with an increased risk of all-cause hospitalization in the 180 days following individual index date. Future analyses comparing a single PIM with its corresponding alternative may help identify those PIMs responsible for this.

[Transfer-time and -rates from inpatient to outpatient care of mental ill persons in Baden Wurttemberg]. / Übergangszeiten und -raten von stationär nach ambulant in der Versorgung psychisch kranker Menschen in Baden-Württemberg.

OBJECTIVE: The time of transfer between discharge from inpatient mental health care and first contact to the outpatient sector is considered to be an indicator for continuity of care. METHODS: This indicator is assessed using health care claims data of one of the mayor health insurances in Baden-Wurttemberg, Germany. RESULTS: About 80 % of cases with the diagnosis of a defined mental disorder sought outpatient care at general or mental health practitioners within six months from discharge. 50 % of them did so within six days, 75 % within three weeks. The majority sought outpatient care at general practitioners. Cases that sought care in outpatient clinics specialized for severe mental illness (SMI) could not be considered in the data. However, considering them by estimation, the rate of cases with SMI seeking outpatient care at mental health practitioners within six months from discharge estimated to be at least 70 %. CONCLUSIONS: General practitioners are an important source for aftercare of mentally ill people discharged from inpatient care. Time of transfer as an indicator can be predominantly assessed by using health claims data in Germany.

What contributes to good patient outcomes in the home treatment of the severely mentally ill: study protocol of a multi-centre analysis.

BACKGROUND: While evidence is available that home treatment could be effective for treating severe mental illness, there is a lack of evidence on what exactly makes home treatment effective. The study presented here aims to develop recommendations for structures and processes in home treatment that are necessary for its effectiveness. METHODS/DESIGN: 14 provider networks of home treatment for severe mental illness will be analyzed and compared according to their structures, processes and patient-related outcomes. Data will be drawn from health care claims data, routine assessments of psychosocial functioning, and from questionnaires on structures and processes. The primary outcome will be psychosocial functioning; secondary outcomes, quality of life and days spent in hospital. The relation between structures and processes on one hand side and outcomes on the other side will be identified by multilevel analysis. In addition, focus groups with patients, relatives and network staff will be held to add further insight into relevant processes. All networks will receive individual quality reports, providing them with feedback on the results of this research and benchmarking them against the average. Based on this research, recommendations for processes and structures of home treatment will be developed. DISCUSSION: The research will use longitudinal data on outcomes routinely assessed since 2009 and claims data. Routine data is also used for the assessment of structures and processes. By way of additional questionnaires developed in discussion with providers, further relevant factors can be included. The approach of this study becomes more comprehensive by conducting focus groups with patients, relatives and providers and by having the chance to evaluate the results with the networks by providing feedback of results. Several factors such as outcomes related to regional availability of hospital beds or size of networks might limit this study.

[Evaluation of family doctor centred medical care based on AOK routine data in Baden-Württemberg]. / Evaluation der Hausarztzentrierten Versorgung in Baden-Württemberg auf der Basis von Routinedaten der AOK.

The agreement on family-doctor centred care (Hausarztzentrierte Versorgung, "HzV") pursuant to Sect. 73b, Volume V of the German Social Security Code became effective in Baden-Wuerttemberg, Germany, on July 1(st), 2008. This complex intervention, which is voluntary for both family doctors and patients, aims to strengthen the coordinative function of family practices. As a result, this intervention is believed to increase the quality of medical health care for persons insured - in the medium to long-term - and thereby, ideally, to additionally save expenses. Working package 1 was one out of a total of four working packages and focused on the evaluation of potential intervention effects of the HzV intervention based on the analyses of AOK routine data in Baden-Wuerttemberg. A total of 1.44 million insured persons were eligible for the present analyses. Insured adults voluntarily participating in the family doctor-centred health care intervention (HzV insured persons: n=580,924 in the intervention group) of the AOK were compared to those not participating in this intervention (non-HzV insured persons: n=862,237 in the control group). For both HzV and non-HzV insured persons, a comparison of each outcome of interest (encounters with family doctors, encounters with specialists, rate of hospitalisations, duration of hospitalisations, rate of re-hospitalisations, costs of pharmacotherapy, rate of polypharmacy, rate of Me-Too pharmaceuticals) was conducted for quarters 3 and 4 of 2008 as well as for quarters 3 and 4 in 2010. Both groups of insured persons differed in that they either participated in the HzV intervention between January 1, 2009 and June 30, 2011 or not. Before January 1, 2009 individuals in both groups did not participate in the HzV intervention. This design allowed for both longitudinal and cross-sectional comparisons. Moreover, the design implicitly controlled for potential seasonal bias. In order to adjust for relevant covariates (insured persons' age, gender, nationality, insurance state, morbidity), multivariate multilevel regression models were developed and applied. On average, HzV insured persons were about 3 years older (56.2 ± 27.3 vs. 53.1 ± 18.4 years) and had higher levels of comorbidity (Charlson Comorbidity Index: 1.45 ± 1.86 vs. 1.19 ± 1.71). No significant differences in terms of rate and duration of hospitalisations were observed. The same applied to the number of rehospitalisations within 30 days. After adjustment for covariates, however, an increase in visits to the respective family doctor of 38% was found in the intervention group. Moreover, a decrease of encounters to specialists with and without referrals from family doctors could be observed (-29.8 % and -12.5%, respectively). Interestingly, even costs of pharmacotherapy, polypharmacy and prescriptions of Me-Too drugs were statistically significantly lower or less frequent, respectively, in the group of HzV insured persons. In conclusion, besides the observed associations in terms of pharmacotherapy, the HzV intervention appears to have advantageous effects in terms of family doctor centred health care.

[Guideline compliance in the treatment of patients with chronic heart failure through family doctor-centred health care: results of an evaluation study]. / Leitliniengerechte Behandlung bei chronischer Herzinsuffizienz im Rahmen der Hausarztzentrierten Versorgung. Ergebnisse einer Evaluationsstudie.

PROBLEM: Family doctor centred health care (German abbreviation: HzV) agreements in Baden-Wuerttemberg provides that every year the strategies and results of at least two high-quality guidelines shall be discussed and worked on in quality circles. In this regard, the 'heart failure' guideline by the German Society of General Practice and Family Medicine (DEGAM) is especially important due to the high treatment costs and the continuously increasing prevalence of this medical condition. Another specified objective of the HzV agreements is to increase the DMP participation rate. The study addressed two questions: Is the medical care provided to patients with chronic heart failure who are being treated under HzV more compliant with guidelines than routine care? Does further improvement result from working on the guidelines in quality circles? METHODS: Routine data were provided by the AOK Baden-Wuerttemberg statutory health insurance company. Patients with heart failure receiving treatment under an HzV agreement (HzV group) were compared with patients receiving routine care (control group) with regard to quality of care eight months before and eight months after working on the guideline on heart failure in quality circles. Primary endpoints were the prescription of ACE inhibitors, AT1 antagonists and beta blockers in accordance with guidelines. Adjustment for various covariates was done by means of multivariate multilevel regression. RESULTS: Data were available for 3,667 practices [1,295 HzV practices; 2,158 non-HzV practices]. After applying validated diagnosis criteria, 16,584 patients were included in the intervention group and 28,992 in the control group. The HzV group received significantly better care in terms of the primary endpoint "prescription of ACE inhibitors or AT1 antagonists" (73.1 % vs. 69.3 % of the patients received ACE inhibitors or AT1 antagonists at T0 (OR 1.40; 95% CI [1,25; 1,57]; p < .001). 54.2 % vs. 52.3 % of the patients received beta blockers at T0 (not significant after adjustment, p = .260). No further improvement could be demonstrated to result from working on guidelines in quality circles. DISCUSSION AND CONCLUSION: The treatment of HzV patients with chronic heart failure is more compliant with guidelines than that of patients receiving routine care. Quality of care was already high at the beginning, and working on guidelines in quality circles had no noticeable effect. The increased DMP participation rate, which is one of the specified objectives of the HzV agreements, appears to have a mediation effect.

Clinical features and treatment of retropharyngeal abscess in children.

OBJECTIVE: To characterize presentation, treatment, and outcomes of pediatric retropharyngeal abscess (RPA) and determine optimal treatment. STUDY DESIGN: Retrospective cohort. SUBJECTS AND METHODS: Chart review of 162 pediatric patients with RPA. RESULTS: Initial treatment was surgery in 126 and intravenous antibiotics in 36, of which 17 required surgery. Findings were negative in 30, murky fluid in 34, and pus in 79. Factors predicting positive surgical drainage were duration of symptoms for more than 2 days, prior antibiotic treatment, and CT lesion cross-sectional area >2.0 cm(2). A history of rash was a negative predictor. The mean length of stay (LOS) was 4.8 vs 3.6 days (P = 0.14), and duration of fever (DOF) was 2.5 vs 1.4 days (P = 0.01) for patients with no fluid and fluid at surgery, respectively. For antibiotic vs surgery groups, LOS was 4.4 vs 3.6 days (P = 0.14) and DOF was 2.4 versus 1.5 days (P = 0.0061). CONCLUSIONS: These predictive factors may be useful in selecting patients with retropharyngeal abscesses who might be treated with intravenous antibiotics alone.