Abordaje del acceso vascular por equipo de terapia infusional: seguridad y calidad asistencial / Approach to vascular access by infusion therapy team: safety and quality of care

Objetivo: describir la evolución del modelo de atención del acceso vascular por un equipo de terapia infusional enfermero referente (ETI) y sus resultados en la seguridad vinculados al acceso vascular central de inserción periférica (PICC) en pacientes oncohematológicos. Métodos: estudio observacional en una cohorte retrospectiva de 3.423 pacientes oncohematológicos a los cuales se les indicó un PICC ambulatoriamente durante 2012-2021. Variables: modelo de atención, motivo de la indicación, método de comprobación de la colocación del acceso, complicaciones del acceso vascular. Recogida de información mediante datos primarios del registro de acceso vascular y registro clínico de la historia informatizada ESPOQ2©. Análisis descriptivo paquete estadístico IBM SPSS® V.23.0 . Resultados: la creación de un equipo referente de terapia infusional incrementó la capacidad de colocación de catéteres, pasando de 98 (2013) a 768 (2021). La indicación del PICC pasó del 45,80% por instauración de quimioterapia mediante bomba de infusión domiciliaria (2016) al 93,70% por indicación por fármaco irritante o vesicante (2021) (p< 0,001). La introducción de la técnica ecoguiada y método electro-intracavitario de control de punta disminuyeron las complicaciones por flebitis mecánicas y la radiación por comprobación de catéter (p< 0,001). Conclusiones: los modelos de atención con equipos de terapia infusional referentes consolidados incrementan la seguridad del paciente oncológico portador de acceso vascular PICC.(AU)

Objective: to describe the evolution of the vascular access care model led by a nurse infusion therapy (ETI) team and its safety results associated with peripherally inserted central vascular access (PICC) in oncohematology patients. Methods: descriptive observational study in a retrospective cohort in 3,423 oncohaematological patients who were indicated for a PICC on an outpatient basis during 2012 to 2021. Variables: Care model, reason for the indication, access placement verification method, vascular access complications. Data collection using primary data from the vascular access registry and clinical registry of the ESPOQ2© computerized history. Descriptive analysis using IBM® SPSS® Statistics V.23.0. Results: infusional teams' reference increased the capacity to place catheters, going from 98 (2013) to 768 (2021). The indication for the PICC went from 45.80% due to initiation of chemotherapy home infusion (2016) to 93.70% due to an indication for an irritant or vesicant drug (2021) (p< 0.001). The introduction of the ultrasound-guided technique and electro-intracavitary method of tip control decreased complications due to mechanical phlebitis and radiation due to catheter verification (p< 0.001). Conclusions: care models with consolidated reference infusion therapy teams increase the safety of cancer patients with PICC vascular access.(AU)

Participatory action research intervention for improving sleep in inpatients with cancer.

AIM: To design and implement a plan to improve oncohaematological patients' sleep. BACKGROUND: The hospital environment can compromise inpatients' sleep, negatively impacting on health outcomes and patient satisfaction. DESIGN AND METHOD: The improvement plan was designed in collaboration with 18 professionals, 3 patients and 3 accompanying relatives. The study designed followed the SQUIRE 2.0 guidelines. Outcome variables were self-reported patient satisfaction regarding sleep, measured using a 30-item, ad hoc questionnaire and a 10-point visual analogue scale, completed by 318 oncohaematological inpatients (pre-intervention n = 120, post-intervention, n = 198) in a comprehensive cancer centre in Spain from 2017 to 2019. RESULTS: Overall, 61.5% (n = 190) of the inpatients reported sleep alterations, and 92.6% reported interruptions in their nightly sleep. Half slept less than 6 h/night, but 58.0% said they felt rested upon waking, despite the interruptions. These outcomes were similar before and after the intervention. The improvement plan identified four domains for work (professionals, care procedures, instruments/environment and patients/relatives), 10 areas for improvement and 35 actions for implementation. However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. The intervention significantly improved variables related to professionals' behaviour, including noise during the shift change, conversations at the control desk and the use of corridor lights. Sleep disturbances were mainly caused by pain/discomfort and infuser alarms, and collectively they decreased significantly after the intervention (p = .008). However, overall sleep worsened significantly, from 6.73 to 6.06 on the 10-point scale. CONCLUSIONS: Pain, clinical devices and noise made by professionals are the main causes of sleep disturbances. Involving professionals in decision-making to improve patients' sleep have a positive impact on noise levels. RELEVANCE TO CLINICAL PRACTICE: This study proposes new strategies for improving sleep by increasing staff awareness and changing attitudes towards patients' sleep. Nurses should be involved in addressing sleep disturbances during hospitalization.

Análisis de la variabilidad del resultado del cultivo para «Streptococcus agalactiae» entre la semana 35-37 de gestación y el ingreso en sala de partos / Analysis of the variability of the culture outcome for «Streptococcus agalactiae» between week 35-37 of gestation and admission to delivery

Objetivo: Analizar la variabilidad del resultado del cultivo para Streptococcus agalactiae entre la semana 35-37 de gestación y el ingreso en sala de partos, así como las posibles variables influyentes en este cambio. Metodología: Estudio observacional, descriptivo y transversal. Se realizó un análisis descriptivo e inferencial, uni y bivariante. Técnica de muestreo no probabilística accidental. Resultados: Participaron 304 mujeres gestantes (608 muestras). La prevalencia de S. agalactiae se situó en el 15,1 % (preingreso) y el 15,6 % (ingreso). El 7,2 % de las mujeres (22) presentaron variabilidad de resultado entre el primer y el segundo cultivos. El 4,2 % (8) positivizó y un 3 % (14) negativizó. El 22,9 % (29) de los casos positivos presentaron cepas resistentes a clindamicina.Un antecedente de cultivo positivo aumentó la probabilidad de positividad cuatro veces durante la gestación actual. Los principales factores que influyeron en el cambio del resultado del cultivo aumentando su probabilidad fueron: la etnia (6,155 veces), el primer cultivo positivo (15,203 veces), la presencia de infecciones de transmisión sexual (3,8 veces), la edad (x2 0,005) y el peso (x2 0,044) con resultados estadísticamente relevantes. (AU)

Purpose: To investigate the variability of the culture result for Streptococcus agalactiae between weeks 35-37 of gestation and admissions to the delivery room and the possible variables influencing this change. Material and methods: An observational, descriptive, cross-sectional study of a series of cases was conducted with 304 (608 cultures) pregnant women. An accidental non-probabilistic sampling technique was used. Results: The results’ variability occurred in 7.2% (22) of the sample, where 4% (9) changed from positive to negative, and 26% (14) changed from negative to positive. The prevalence of pregnant women with positive Streptococcus agalactiae was 50 positives in the first culture (15.6%) and 46 (15.1%) in a second time. 4.2% (8) were positive and 3% (14) were negative. 22.9% (29) of the positive cases presented strains resistant to clindamycin.Presenting a history of positive culture in another pregnancy increased the probability of positivity four times during the current pregnancy. Likewise, obtaining a positive result in the first culture registered the probability of continuing to be positive in subsequent determinations in 9.5 times. The presence of a history of sexually transmitted infections increased the probability of suffering a change in result by 3.8 times. (AU)

Evidence on port-locking with heparin versus saline in patients with cancer not receiving chemotherapy: A randomized clinical trial.

Objective: To assess the safety and efficacy of port-locking with heparin every 2 months vs. every 4 months and vs. saline solution every 2 months in patients with cancer not receiving active chemotherapy. The hypothesis stated that locking with heparin at four-month intervals and saline at two-month intervals would not increment > 10% of port obstructions. Methods: Multicentre, phase IV parallel, post-test control group study took place at the two chemotherapy units of oncology hospitals. Included patients with cancer with ports that completed the chemotherapy treatment but still having port maintenance care or blood samples taken up to four months. A sample of 126 patients with cancer in three arms was needed to detect a maximum difference of 10% for bioequivalence on the locking methods. Consecutive cases non-probabilistic sampling and randomized to one of the three groups; group A: received heparin 60 IU/mL every two months (control) vs. group B heparin every four months and vs. saline every two months in group C. Primary variables were the type of locking regimen, port obstruction, and absence of blood return, port-related infection, or venous thrombosis during the study period. Clinical and sociodemographic variables were also collected. Results: A total of 143 patients were randomly assigned; group A, 47 patients with heparin every 2 months, group B, 51 patients with heparin 4 months, and group C, 45 patients with saline every 2 months. All participants presented an adequate blood return and no obstructions, until the month of the 10th, when one participant in the group A receiving was withdrawn due to an absence of blood flow (P â€‹= â€‹0.587). Conclusions: Port locks with heparin every 4 months or saline every 2 months did not show differences in safety maintenance, infection, or thrombosis compared to heparin every 2 months.

Origin of thyrotropin-releasing hormone neurons that innervate the tuberomammillary nuclei.

Hypophysiotropic thyrotropin-releasing hormone (TRH) neurons function as metabolic sensors that regulate the thyroid axis and energy homeostasis. Less is known about the role of other hypothalamic TRH neurons. As central administration of TRH decreases food intake and increases histamine in the tuberomammillary nuclei (TMN), and TMN histamine neurons are densely innervated by TRH fibers from an unknown origin, we mapped the location of TRH neurons that project to the TMN. The retrograde tracer, cholera toxin B subunit (CTB), was injected into the TMN E1-E2, E4-E5 subdivisions of adult Sprague-Dawley male rats. TMN projecting neurons were observed in the septum, preoptic area, bed nucleus of the stria terminalis (BNST), perifornical area, anterior paraventricular nucleus, peduncular and tuberal lateral hypothalamus (TuLH), suprachiasmatic nucleus and medial amygdala. However, CTB/pro-TRH178-199 double-labeled cells were only found in the TuLH. The specificity of the retrograde tract-tracing result was confirmed by administering the anterograde tracer, Phaseolus vulgaris leuco-agglutinin (PHAL) into the TuLH. Double-labeled PHAL-pro-TRH boutons were identified in all subdivisions of the TMN. TMN neurons double-labeled for histidine decarboxylase (Hdc)/PHAL, Hdc/Trh receptor (Trhr), and Hdc/Trh. Further confirmation of a TuLH-TRH neuronal projection to the TMN was established in a transgenic mouse that expresses Cre recombinase in TRH-producing cells following microinjection of a Cre recombinase-dependent AAV that expresses mCherry into the TuLH. We conclude that, in rodents, the TRH innervation of TMN originates in part from TRH neurons in the TuLH, and that this TRH population may contribute to regulate energy homeostasis through histamine Trhr-positive neurons of the TMN.

Are Unilateral Devices Valid for Power Output Determination in Cycling? Insights From the Favero Assioma Power Meter.

PURPOSE: Some power meters are available in both bilateral and unilateral versions. However, despite the popularity of the latter, their validity remains unknown. We aimed to analyze the validity of a unilateral pedal power meter for estimating actual ("bilateral") power output (PO). METHODS: Thirty-three male cyclists were assessed at different POs (steady cycling at 100-500 W, as well as all-out sprints), pedaling cadences (70, 85, and 100 repetitions·min-1), and cycling positions (seated and standing). The PO estimated by a left-only power meter (Favero Assioma Uno) was compared with the actual PO computed by a bilateral power meter (Favero Assioma Duo), and the level of bilateral asymmetry (most- vs least-powerful leg) with the latter system was also computed. RESULTS: Nonsignificant differences, high intraclass correlation coefficients (≥.90), and low coefficients of variation (consistently ≤5% except for low PO levels, ie, 5%-7% at 100 W) were found between Favero Assioma Uno and Favero Assioma Duo. However, although a strong intraclass correlation coefficient (.995) was found between both legs, asymmetry values of 4% to 6% were found for all conditions except when pedaling at the lowest PO (100 W), in which asymmetry increased up to 10% to 13%. CONCLUSIONS: Although cyclists tend to present some level of bilateral asymmetry during cycling (particularly at low PO), Favero Assioma Uno provides overall valid estimates of actual PO and is, therefore, an economical alternative to bilateral power meters. Caution is needed, however, when interpreting data at the individual level in cyclists with high levels of asymmetry.

Infecciones de transmisión sexual e influencia en la positividad y/o modificación del resultado del cultivo para Streptococcus agalactiae durante la gestación / Sexually transmitted infections and influence on positivity and/or modification of culture results for Streptococcus agalactiae during gestation

Objetivo: Analizar la relación entre las infecciones de transmisión sexual (ITS) y la positividad para Streptococcus agalactiae (SGB) y/o la modificación del resultado del cultivo para SGB durante el tercer trimestre de gestación. Metodología: Estudio observacional, descriptivo y transversal de serie de casos en gestantes durante el periodo 2016-2018. Muestreo no probabilístico, accidental consecutivo, con un análisis descriptivo e inferencial y una recogida de datos ambispectiva. Resultados: La muestra del estudio fue de 304 gestantes (608 cultivos). La prevalencia de SGB en gestantes fue de 48 (15,3%). Existió una variabilidad de resultados entre los cultivos de 22 (7,2%). Un total de 25 gestantes (8,2%) presentaron antecedentes de ITS, lo que multiplicó el riesgo en 3,8 veces (p= 0,01) para la modificación y/o positividad del cultivo. No se halló asociación entre el tipo de ITS y el cultivo positivo para SGB y/o modificación de éste. Conclusiones: El estudio actualiza la prevalencia de SGB en nuestro medio en el 15,1-15,6%, y muestra una variabilidad del resultado del cultivo para SGB durante el tercer trimestre de gestación del 7,2%.El antecedente de ITS se asoció con una mayor probabilidad de modificación del cultivo para SGB (p= 0,01), así como de positividad del cultivo para SGB (p= 0,01) durante el tercer trimestre de gestación.Se debería considerar el antecedente de ITS, dada su influencia en el resultado final y/o positividad del cultivo rectovaginal. Se precisarían estudios de mayor amplitud y prospectivos para optimizar el cribado para SGB durante la gestación. (AU)

Objective: To analyze the relationship between sexually transmitted infections (STIs) and positivity for Streptococcus agalactiae (GBS) and/or the modification of the culture result during third trimester of pregnancy.Methodology: Observational, descriptive, cross-sectional study of a series of cases in pregnancy women during the years 2016-2018. Non probabilistic, accidental and consecutive sampling with a descriptive and inferential analysis.Results: The study sample was 304 pregnant women (608 cultures). The prevalence of GBS was 48 (15.3%). There was a variability of results between the cultures of 22 (7.2%). 25(8.2%) of the pregnant women had a history of STIs, multiplying the risk by 3.8 times (p= 0.01) for the modification and/or positivity of the culture. There was no association between the type of STIs and the positive culture for GBS and/or its modification.Conclusions: The study updates the prevalence of GBS in our environment and shows a variability of between 15.1-15.6% and variability for the result of the culture during the third trimester of pregnancy of 7.2%.The history of STI was also associated with a greater probability of modification (p= 0.01) and positivity (p= 0.01) of the culture for GBS during the third trimester of gestation.A history of STI should be considered given its influence on the result and positivity of the vaginal-rectal culture. A larger study is required to optimize screening for GBS in pregnancy. (AU)

The effect of experience on the psychophysiological response and shooting performance under acute physical stress of soldiers.

Present research studied the psychophysiological response and shooting performance taking into consideration the experience of the soldier after a physical stress protocol, which leaded to acute fatigue conditions. Sixty soldiers were divided into experienced and non-experienced groups to conduct a high-intensity interval training (HIIT) based on endurance type exercises (10 intervals of 40 m run at maximum intensity with 2 changes of direction and 45 s of recovery. Psychophysiological and shooting performance variables were measured before, during and after the HIIT protocol. Significant increases in heart rate, blood lactate, lower limbs strength, as well as a significant decrease in blood oxygen saturation and body temperature were found in both groups. Shooting performance was affected by experience and fatigue, being more accentuated in non-experienced. Present HIIT protocol elicited a similar psychophysiological response than in previously reported combat manoeuvres, thus proving to be an optimal stimuli approach/intervention for soldier's specific physical preparation.

Relationship Between Critical Power and Different Lactate Threshold Markers in Recreational Cyclists.

Purpose: To analyze the relationship between critical power (CP) and different lactate threshold (LT2) markers in cyclists. Methods: Seventeen male recreational cyclists [33 ± 5 years, peak power output (PO) = 4.5 ± 0.7 W/kg] were included in the study. The PO associated with four different fixed (onset of blood lactate accumulation) and individualized (Dmaxexp, Dmaxpol, and LTΔ1) LT2 markers was determined during a maximal incremental cycling test, and CP was calculated from three trials of 1-, 5-, and 20-min duration. The relationship and agreement between each LT2 marker and CP were then analyzed. Results: Strong correlations (r = 0.81-0.98 for all markers) and trivial-to-small non-significant differences (Hedges' g = 0.01-0.17, bias = 1-9 W, and p > 0.05) were found between all LT2 markers and CP with the exception of Dmaxexp, which showed the strongest correlation but was slightly higher than the CP (Hedges' g = 0.43, bias = 20 W, and p < 0.001). Wide limits of agreement (LoA) were, however, found for all LT2 markers compared with CP (from ±22 W for Dmaxexp to ±52 W for Dmaxpol), and unclear to most likely practically meaningful differences (PO differences between markers >1%, albeit <5%) were found between markers attending to magnitude-based inferences. Conclusion: LT2 markers show a strong association and overall trivial-to-small differences with CP. Nevertheless, given the wide LoA and the likelihood of potentially meaningful differences between these endurance-related markers, caution should be employed when using them interchangeably.

Validity of the Favero Assioma Duo Power Pedal System for Measuring Power Output and Cadence.

Cycling power meters enable monitoring external loads and performance changes. We aimed to determine the concurrent validity of the novel Favero Assioma Duo (FAD) pedal power meter compared with the crank-based SRM system (considered as gold standard). Thirty-three well-trained male cyclists were assessed at different power output (PO) levels (100-500 W and all-out 15-s sprints), pedaling cadences (75-100 rpm) and cycling positions (seating and standing) to compare the FAD device vs. SRM. No significant differences were found between devices for cadence nor for PO during all-out efforts (p > 0.05), although significant but small differences were found for efforts at lower PO values (p < 0.05 for 100-500 W, mean bias 3-8 W). A strong agreement was observed between both devices for mean cadence (ICC > 0.87) and PO values (ICC > 0.81) recorded in essentially all conditions and for peak cadence (ICC > 0.98) and peak PO (ICC > 0.99) during all-out efforts. The coefficient of variation for PO values was consistently lower than 3%. In conclusion, the FAD pedal-based power meter can be considered an overall valid system to record PO and cadence during cycling, although it might present a small bias compared with power meters placed on other locations such as SRM.

Validity and reliability of the Spanish version of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-B).

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-B) is an instrument that allows the experiences around fear of childbirth to be examined after the birth. It is currently the most widely used to measure different aspects related to the fear of childbirth and enables healthcare and additional assistance to women after birth to be adapted according to their needs. The objective of this study was to translate the W-DEQ-B into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) transcultural adaption of the questionnaire to Spanish and (2) a transversal study in a sample of 190 postpartum women from Sexual and Reproductive Health Clinics in the province of Barcelona (Spain). The psychometric properties were examined in terms of reliability (internal consistency and temporal stability) and construct validity (confirmatory factorial analysis [CFA] and exploratory factorial analysis [EFA]). The results of the CFA did not confirm unidimensionality of the W-DEQ-B questionnaire. The EFA suggested four very similar, but not identical, dimensions to those obtained in other studies in which the W-DEQ-B has been evaluated. Both the Cronbach's alpha and the omega coefficient were adequate for the total questionnaire and for each of the four dimensions. The results of this study confirm that the W-DEQ-B is multi-dimensional. In the Spanish version of the W-DEQ-B-Sp four dimensions have been identified that allow the experiences around fear of childbirth to be examined after the birth. The Spanish version of the WDEQ-B (WDEQ-B-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

Performance Parameters in Competitive Alpine Skiing Disciplines of Slalom, Giant Slalom and Super-Giant Slalom.

The objective of this study was to describe the kinematic patterns and impacts in male and female skiers in the super-giant slalom, giant slalom and slalom disciplines of an international alpine skiing competition using a portable Global Navigation Satellite Systems (GNSS) technology device. Fifteen skiers (males, n = 9, females, n = 6) volunteered to participate in this study. Data acquisition was carried out using a wireless inertial measurement device (WIMUTM PRO: hybrid location system GNSS at 18 Hz with a precision locator UltraWideband UWD (<10 cm) and 3D accelerometers 1000 Hz) where distances covered in different speed and acceleration thresholds and impacts above 5g were recorded in each of the disciplines. Male and female alpine skiers showed different physical parameters and impacts even though they competed in the same courses in the disciplines of slalom, giant slalom and super-giant slalom (total impacts: p < 0.001; impacts > 7 g: p = 0.013; impacts 6.1-7 g: p = 0.002; impacts 5.1-6 g: p = 0.006). In male skiers, the distances traveled at different speed thresholds have a direct relation to the ranking of skiers, but this ideal threshold decreased as the technicality of the discipline increased. In the case of female skiers, although no relation was seen with the speed thresholds, greater distances covered at medium accelerations improved skiing performance. The external load in alpine skiing varied based on sex and discipline. This information could be essential to develop sex-specific and discipline-specific training programs in alpine skiing.

Traditional Versus Velocity-Based Resistance Training in Competitive Female Cyclists: A Randomized Controlled Trial.

We assessed the effects of a short-term velocity-based resistance training (VBRT, where exercise intensity is individualized based on the loads and repetitions that maximize power output) program compared with traditional resistance training (TRT, where the same number of repetitions and relative load are used for every individual) on body composition, muscle strength/power, and endurance performance in competitive female cyclists. Seventeen participants were randomly assigned to 6 weeks (two sessions/week) of TRT (n = 8) or VBRT (n = 9), during which they maintained their usual endurance program. Both interventions included squat, hip thrust, and split squat exercises. Training loads were continuously registered, and outcomes were measures of muscle strength/power, body composition, and endurance performance (incremental test and 8-min time trial). No differences between TRT and VBRT groups were found for overall internal training loads during resistance training or cycling sessions (p > 0.05). Both interventions led to significant improvements in all strength/power-related outcomes, but VBRT induced greater improvements than TRT in maximum muscle strength and power as assessed with the hip thrust exercise (p < 0.05 for the group by time interaction effect). However, no significant group by time interaction effect was found for body composition or endurance performance-related outcomes. In conclusion, the addition of a short-term intervention of VBRT or TRT to the usual training regimen of competitive female cyclists improves muscle strength/power, albeit VBRT might induce superior gains on maximum strength/power for the hip thrust exercise.

Reliability and validity study of the Spanish adaptation of the "Wijma Delivery Expectancy/Experience Questionnaire" (W-DEQ-A).

The Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-A) is an instrument that evaluates fear of childbirth through the expectations of women in relation to childbirth and their experience during the birth. The objective of this study was to translate the W-DEQ-A into Spanish and analyse its reliability and validity. The study was carried out in two phases: (1) adapting the questionnaire to Spanish and (2) a transversal study in a sample of 273 pregnant women in the Sexual and Reproductive Health centres in the Metropolitan Northern Barcelona in Catalonia (Spain). The psychometric properties were analysed in terms of reliability and construct validity. The confirmatory factorial analysis did not confirm the unidimensionality of the original structure of the WDEQ-A, as happened with the other studies in which it has previously been validated. The result of the exploratory factorial analysis suggests four factors, or dimensions, very similar but not identical to those obtained in other analysis studies of the W-DEQ-A. The Cronbach alpha and the omega scale were also adequate for all the scales and for each of the dimensions. The results of this study confirm the findings of other studies that suggest that the W-DEQ-A is multi-dimensional. In the Spanish version of the W-DEQ-A four dimensions have been identified to explore fear of childbirth in pregnant women. The Spanish version of the WDEQ-A (WDEQ-A-Sp) is reliable and valid for the measurement of fear of childbirth in clinical practice and for use in future research.

On- Versus Off-Bike Power Training in Professional Cyclists: A Randomized Controlled Trial.

PURPOSE: To compare the effectiveness of resistance power training (RPT, training with the individualized load and repetitions that maximize power output) and cycling power training (CPT, short sprint training) in professional cyclists. METHODS: The participants (20 [2] y, peak oxygen uptake 78.0 [4.4] mL·kg-1·min-1) were randomly assigned to perform CPT (n = 8) or RPT (n = 10) in addition to their usual training regime for 7 weeks (2 sessions/wk). The training loads were continuously registered using the session rating of perceived exertion. The outcomes included endurance performance (8-min time trial and incremental test), as well as measures of muscle strength/power (1-repetition maximum and mean maximum propulsive power on the squat, hip thrust, and lunge exercises) and body composition (assessed by dual-energy X-ray absorptiometry). RESULTS: No between-group differences were found for training loads or for any outcome (P > .05). Both interventions resulted in increased time-trial performance, as well as in improvements in other endurance-related outcomes (ie, ventilatory threshold, respiratory compensation point; P < .05). A significant or quasi-significant increase (P = .068 and .047 for CPT and RPT, respectively) in bone mineral content was observed after both interventions. A significant reduction in fat mass (P = .017), along with a trend (P = .059) toward a reduced body mass, was observed after RPT, but not CPT (P = .076 for the group × time interaction effect). Significant benefits (P < .05) were also observed for most strength-related outcomes after RPT, but not CPT. CONCLUSION: CPT and RPT are both effective strategies for the improvement of endurance performance and bone health in professional cyclists, although the latter tends to result in greater improvements in body composition and muscle strength/power.

Traditional Versus Optimum Power Load Training in Professional Cyclists: A Randomized Controlled Trial.

PURPOSE: To compare the effectiveness of optimum power load training (OPT, training with an individualized load and repetitions that maximize power output) and traditional resistance training (TRT, same number of repetitions and relative load for all individuals) in professional cyclists. METHODS: Participants (19 [1] y, peak oxygen uptake 75.5 [6] mL/kg/min) were randomly assigned to 8 weeks (2 sessions per week) of TRT (n = 11) or OPT (n = 9), during which they maintained their usual cycle training schedule. Training loads were continuously registered, and measures of muscle strength/power (1-repetition maximum and maximum mean propulsive power on the squat, hip thrust, and lunge exercises), body composition (assessed by dual-energy X-ray absorptiometry), and endurance performance (assessed on both an incremental test and an 8-min time trial) were collected before and at the end of the intervention. RESULTS: OPT resulted in a lower average intensity (percentage of 1-repetition maximum) during resistance training sessions for all exercises (P < .01), but no differences were found for overall training loads during resistance or cycling sessions (P > .05). Both programs led to significant improvements in all strength/power-related parameters, muscle mass (with no changes in total body mass but a decreased fat mass), and time-trial performance (all Ps < .05). A trend toward increased power output at the respiratory compensation point was also found (P = .056 and .066 for TRT and OPT, respectively). No between-groups differences were noted for any outcome (P > .05). CONCLUSION: The addition of either TRT or OPT to an endurance training regimen of elite cyclists results in similar improvements of body composition, muscle strength/power, and endurance performance.

The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative: Standardization of Care for Opioid-Exposed Newborns Shortens Length of Stay and Reduces Number of Infants Requiring Opiate Therapy.

OBJECTIVES: To decrease the average length of stay (LOS) of opioid-exposed newborns (OENs) by 20% from baseline from April 2017 to December 2019. METHODS: The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative is a consortium of neonatal providers, public health experts, and legislative experts that provides infrastructure and resources for Colorado birthing hospitals to undertake initiatives focused on improving the care of OENs. The Colorado Hospitals Substance Exposed Newborn Quality Improvement Collaborative was started in September 2017 and includes 19 birthing hospitals in Colorado, with 12 contributing data to the centralized database. The interventions were focused on (1) hospital engagement and (2) increasing nonpharmacologic care (by using the Eat, Sleep, Console assessment tool; developing guidelines for breastfeeding eligibility; employing comfort measures before pharmacologic therapy; and administering opiate therapy on an as-needed basis). RESULTS: From April 2017 to December 2019, 787 OENs were identified. Among infants ≥35 weeks' gestational age without other medical diagnoses (n = 647), statistical process control charts revealed significant reduction in the primary outcome of interest, average hospital LOS, from 14.8 to 5.9 days. For all OENs, receipt of pharmacologic therapy declined from 61% to 23%. Among OENs who received pharmacologic therapy (and were ≥35 weeks' gestational age without other medical diagnoses), average LOS also declined from 21.9 to 8.0 days. CONCLUSIONS: Through standardization of OEN care focused on family engagement and nonpharmacologic care, this statewide collaborative reduced average LOS, the percentage of OENs requiring opiate therapy, and average LOS for OENs requiring opiate therapy.

Functional Threshold Power: Relationship With Respiratory Compensation Point and Effects of Various Warm-Up Protocols.

PURPOSE: The functional threshold power (FTP), which demarcates the transition from steady state to non-steady-state oxidative metabolism, is usually determined with a 20-minute cycling time trial that follows a standard ∼45-minute warm-up. This study aimed to determine if the standard warm-up inherent to FTP determination is actually necessary and how its modification or removal affects the relationship between FTP and the respiratory compensation point (RCP). METHODS: A total of 15 male cyclists (age 35 [9] y, maximum oxygen uptake 66.4 [6.8] mL·kg-1·min-1) participated in this randomized, crossover study. Participants performed a ramp test for determination of RCP and maximum oxygen uptake. During subsequent visits, they performed a 20-minute time trial preceded by the "standard" warm-up that is typically performed before an FTP test (S-WU), a 10-minute warm-up at the power output (PO) corresponding to 60% of maximum oxygen uptake (60%-WU), or no warm-up (No-WU). FTP was computed as 95% of the mean PO attained during the time trial. RESULTS: Although the FTP was correlated with the RCP independently of the warm-up (r = .89, .93, and .86 for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001), the PO at RCP was higher than the FTP in all cases (bias ± 95% limits of agreement = 57 [24], 60 [23], and 57 [32] W for No-WU, 60%-WU, and S-WU, respectively; all Ps < .001 and effect size > 1.70). CONCLUSIONS: The FTP is highly correlated with the RCP but corresponds to a significantly lower PO, being these results independent of the warm-up performed (or even with no warm-up).

Physiological Predictors of Competition Performance in CrossFit Athletes.

The aim of this study was to determine the physiological variables that predict competition performance during a CrossFit competition. Fifteen male amateur CrossFit athletes (age, 35 ± 9 years; CrossFit experience, 40 ± 27 months) performed a series of laboratory-based tests (incremental load test for deep full squat and bench press; squat, countermovement and drop jump tests; and incremental running and Wingate tests) that were studied as potential predictors of CrossFit performance. Thereafter, they performed the five Workouts of the Day (WODs) corresponding to the CrossFit Games Open 2019, and we assessed the relationship between the laboratory-based markers and CrossFit performance with regression analyses. Overall CrossFit performance (i.e., final ranking considering the sum of all WODs, as assessed by number of repetitions, time spent in exercises or weight lifted) was significantly related to jump ability, mean and peak power output during the Wingate test, relative maximum strength for the deep full squat and the bench press, and maximum oxygen uptake (VO2max) and speed during the incremental test (all p < 0.05, r = 0.58-0.75). However, the relationship between CrossFit Performance and most laboratory markers varied depending on the analyzed WOD. Multiple linear regression analysis indicated that measures of lower-body muscle power (particularly jump ability) and VO2max explained together most of the variance (R2 = 81%, p < 0.001) in overall CrossFit performance. CrossFit performance is therefore associated with different power-, strength-, and aerobic-related markers.

Factors associated with receipt of the 5As model of brief intervention for smoking cessation among hospitalized patients.

BACKGROUND AND AIMS: Guidelines recommend the 5As model of brief intervention for providing smoking cessation support in clinical settings. This study assessed patient and hospital characteristics associated with self-reported receipt of the 5As (ask, advise, assess, assist and arrange). DESIGN: Multi-center cross-sectional study. SETTING AND PARTICIPANTS: Adult inpatients (n = 1047) were randomly selected from 13 hospitals in the Barcelona province of Spain in 2014-2015. MEASUREMENTS: We explored participants' receipt of the 5As through a questionnaire. Given the progressiveness of the 5As, we recoded the fulfillment of the intervention as: A0 : no intervention; A1 : ask; A2 : ask and advise; A3 : A2 and assess; A4 : A3 and assist; and A5 : A4 and arrange a follow-up. We explored patient (e.g. age, sex, comorbidities) and hospital (e.g. type of hospital, unit) characteristics. We adjusted multi-level robust Poisson regression models to estimate the adjusted prevalence ratios (aPR) of the association between the recoded 5As intervention received. FINDINGS: A total of 60.4% (n = 624) of patients had been asked (A1 ) about their smoking status. Among smokers, 46.5% (n = 90) were advised (A2 ), 26.6% (n = 48) assessed (A3 ) and 4.6% (n = 10) received all the components of the 5As (A5 ). Middle-aged smokers [aPR = 3.63; 95% confidence interval (CI) = 1.69-7.79] with a respiratory disease (aPR = 2.19; 95% CI = 1.11-4.34) were most likely to have been asked, advised and assessed (A3 ). The cessation intervention was most frequently performed by physicians. CONCLUSIONS: In the Barcelona province of Spain, it appears that fewer than half of hospitalized patients who smoke were advised to quit and few received the full 'five As' brief intervention for smoking cessation.