Predefined vs data-guided training prescription based on autonomic nervous system variation: A systematic review

Monitoring variations in the functioning of the autonomic nervous system may help personalize training of runners and provide more pronounced physiological adaptations and performance improvements. We systematically reviewed the scientific literature comparing physiological adaptations and/or improvements in performance following training based on responses of the autonomic nervous system (ie, changes in heart rate variability) and predefined training. PubMed, SPORTDiscus, and Web of Science were searched systematically in July 2019. Keywords related to endurance, running, autonomic nervous system, and training. Studies were included if they (a) involved interventions consisting predominantly of running training; (b) lasted at least 3 weeks; (c) reported pre- and post-intervention assessment of running performance and/or physiological parameters; (d) included an experimental group performing training adjusted continuously on the basis of alterations in HRV and a control group; and (e) involved healthy runners. Five studies involving six interventions and 166 participants fulfilled our inclusion criteria. Four HRV-based interventions reduced the amount of moderate- and/or high-intensity training significantly. In five interventions, improvements in performance parameters (3000 m, 5000 m, Loadmax, Tlim) were more pronounced following HRV-based training. Peak oxygen uptake () and submaximal running parameters (eg, LT1, LT2) improved following both HRV-based and predefined training, with no clear difference in the extent of improvement in . Submaximal running parameters tended to improve more following HRV-based training. Research findings to date have been limited and inconsistent. Both HRV-based and predefined training improve running performance and certain submaximal physiological adaptations, with effects of the former training tending to be greater.     

Effectiveness of cognitive rehabilitation for people with multiple sclerosis: a meta-synthesis of patient perspectives

While previous randomised controlled trials and meta-analyses offer only limited evidence for the effectiveness of cognitive rehabilitation, qualitative studies examining patient perspectives report more positive outcomes. This meta-synthesis of qualitative studies examined patient perspectives of cognitive rehabilitation for memory, attention, and executive function problems in people with multiple sclerosis. Using set eligibility criteria, we screened electronic databases, reference lists, and academic networks for relevant papers. Seven papers (195 participants) were selected. Two independent researchers conducted quality appraisals of papers. Data analysis, guided by the thematic synthesis approach, yielded six main themes. These suggested that patients benefitted from the group environment in rehabilitation. Cognitive rehabilitation facilitated the participants’ reflection and awareness of their cognitive deficits, and was associated with increased knowledge and understanding of their illness. Increased strategy use was reported and associated with improvements in cognitive functioning and greater confidence and perseverance. Participants reported emotional and social improvements, and felt more optimistic. Overall, these changes had a positive impact on participants’ quality of life. This synthesis of qualitative studies indicates that people with multiple sclerosis who experience cognitive deficits benefit from cognitive rehabilitation programmes. This finding must, however, be viewed in light of the limitations of this meta-synthesis. The meta-synthesis was registered in the PROSPERO database under CRD42017040148.     

Improving Surgical Training

Improving Surgical Training is a programme piloting an innovative, evidence-based approach to training. It was developed in response to the Shape of Training report which reviewed postgraduate training and recommended changes in medical education to meet the demands of the modern NHS. A series of initiatives have been developed to enhance the experience for surgical trainees not only to encourage a more focussed and supported method, but also to improve their job satisfaction. The initiatives have combined a greater emphasis on time for training provided by trainers with allocated time for training with multidisciplinary teamworking and the use of technology enhanced learning with simulation of both technical and non-technical skills. The pilot started in 2018 with core training in general surgery and has been expanded to include vascular surgery, urology and trauma and orthopaedics over the last 2 years. Initial feedback from both trainees, trainers and schools of surgery have identified different challenges to aid implementation. The programme is being very carefully evaluated by an independent company as well as careful oversight by the General Medical Council which are paramount to its success.     

镇江市护士分层培训及分层进阶现况分析

目的调查镇江市各医院护士分层培训及分层进阶的方法及现状。方法2018年4—5月间采用自行设计的调查问卷,对全市医院的护理人员进行随机抽样调查。结果调查显示镇江市96.45%的护士受医院分层培训及分层进阶这一模式的管理。其中N1占16.77%,N2占29.5%,N3占41.9%,N4占8.7%,其他占3.11%。有24.53%的护士对医院目前的分层培训方式感到满意并认为无需改进,40.99%的护士表示满意,但需要改进,29.19%的护士表示基本满意,需要改进,5.28%的护士表示不满意需要较大改进。95.82%的医院科室对不用层级的护士有不同的核心能力要求并根据不同核心能力要求进行培训。结论护士分层培训几分层进阶这一管理模式在镇江各医院都有体现,但各医院实行的方式有较大差异,配套的管理方式也有待完善。     

Cognitive training as a resolution for early executive function difficulties in children with intellectual disabilities

Core executive functions (EF) such as attention, and working memory have been strongly associated with academic achievement, language development and behavioral stability. In the case of children who are vulnerable to cognitive and learning problems because of an underlying intellectual disability, EF difficulties will likely exacerbate an already compromised cognitive system. The current review examines cognitive training programs that aim to improve EF, specifically focusing on the potential of this type of intervention for children who have intellectual disabilities. We conclude that despite considerable discrepancies regarding reported intervention effects, these inconsistencies can be attributed to flaws in both program and study design. We discuss the steps needed to address these limitations and to facilitate the advancement of non-pharmaceutical interventions for children with intellectual disabilities.     

妇科腹腔镜围手术期碳水化合物口服疗法对术后胰岛素抵抗影响的研究

目的观察妇科腹腔镜手术围术期碳水化合物口服疗法和传统禁饮食方案两种不同的临床处理措施对于术后胰岛素抵抗（IR）的影响。 方法选取2018年2月至8月入住徐州医科大学附属医院妇科，行腹腔镜下全子宫切除手术的非糖尿病患者共98例，将采用围术期碳水化合物口服疗法者作为观察组（50例），采用传统禁饮食方案者作为对照组（48例）。检测所有病例的术前、术后第1天及第3天的空腹血糖（FPG）及空腹胰岛素（FINS），并利用稳态模式评估法计算稳态模型胰岛素抵抗指数（HOME-IR）。对于观察组与对照组患者术前、术后第1天和术后第3天的FPG、FINS和HOME-IR等指标，组间比较采用独立样本t检验。两组患者术后腹胀、术后24 h通气、术后发热的发生情况的比较采用确切概率法检验。 结果观察组与对照组比较，术前和术后第1天FPG差异无统计学意义（P均>0.05），术后第3天FPG明显降低［（4.34±0.59）mmol/L vs （4.96±0.64）mmol/L］，差异有统计学意义（t=-4.96，P=0.002）。观察组与对照组比较，术前和术后第1天FINS差异无统计学意义（P均>0.05），术后第3天FINS明显降低［（45.39±13.55）mIU/L vs （51.18±9.34） mIU/L］，差异有统计学意义（t=-2.46，P=0.033）。观察组与对照组比较，术前HOME-IR差异无统计学意义（P>0.05），术后第1天和术后第3天HOME-IR明显降低［（13.08±4.80）vs （15.03±4.11）；（9.37±3.65）vs （11.30±2.55）］，差异有统计学意义（t=-0.69，P=0.042；t=-3.99，P=0.033）。两组患者术后其他观察指标比较，观察组术后24 h通气率与对照组比较明显增高（76.0% vs 64.6%），差异有统计学意义（P=0.045）。两组患者在术后腹胀、术后发热的发生率方面差异无统计学意义（P均>0.05）。两组患者均未发生术中误吸。 结论妇科腹腔镜手术围术期应用碳水化合物口服疗法较传统禁饮食方案，能有效减轻术后IR程度，促进术后康复进程，且不增加围术期并发症的发生率。