Rethinking glycaemic control in critical illness — from concept to clinical practice change
Geoffrey M. ShawJ. Geoffrey ChaseJason WongJessica LinThomas LotzAaron J. Le CompteTimothy R. LonerganMichael WillacyChristopher E. Hann
7
Citation
38
Reference
10
Related Paper
Citation Trend
Abstract:
Objective: To examine the practical difficulties in managing hyperglycaemia in critical illness and to present recently developed model-based glycaemic management protocols to provide tight control. Background: Hyperglycaemia is prevalent in critical care. Current published protocols require significant added clinical effort and have highly variable results. No currently published methods successfully address the practical clinical difficulties and patient variation, while also providing safe, tight control. Methods: We developed a unique model-based approach that manages both nutritional inputs and exogenous insulin infusions. Computerised glycaemic control methods and proof-of-concept clinical trial results are presented. The protocol has been simplified to a set of tables and adopted as a clinical practice change. Eight pilot test cases are presented to demonstrate the overall approach. Results: Computerised control methods lowered blood glucose (BG) levels to the range 4.0–6.1mmol/L within 10 hours. Over 90% of pre-set hourly blood glucose targets were achieved within measurement error. Eight pilot tests of the simplified, table-based SPRINT protocol, covering 1651 patient-hours produced an average BG level of 5.7mmol/L (SD, 0.9mmol/L). BG levels were in the 4.0–6.1mmol/L band for 60% of the controlled time. Just under 90% of measurements were in the range 4.0–7.0mmol/L, with 96% in the range 4.0–7.75 mmol/L. There were no hypoglycaemic episodes, with a minimum glucose level of 3.2 mmol/L, and no additional clinical intervention was required. Summary: The overall approach of modulating nutrition as well as insulin challenges the current practice of relying on insulin alone to reduce glycaemic levels, which often results in large variability and poor control. The protocol was developed from model-based analysis and proof-of-concept clinical trials, and then generalised to a simple, clinical practice improvement. The results show extremely tight control within safe glycaemic bands.Keywords:
Clinical Practice
Sprint
To investigate the relationship between anthropometrics and sprint and agility performance and describe the development of sprint (acceleration) and agility performance in 10- to 16-year-old male soccer players.One hundred and thirty-two participants were divided into three age groups, 10-12 years (mean 10.8±0.50), 13-14 years (mean 13.9±0.50), and 15-16 years (mean 15.5±0.24), with assessment of 20 m sprint with 10 m split time and agility performance related to body height and body mass within groups.In the 10- to 12-year-olds, there were no significant correlations between height, weight, and the performance variables, except for body mass, which was correlated to 10-20 m sprint (r=0.30). In the 13- to 14-year-olds, body height was significantly correlated with 10 m sprint (r=0.50) and 20 m sprint (r=0.52), as well as 10-20 m sprint (r=0.50) and agility performance (r=0.28). In the 15- to 16-year-old group, body height was correlated to 20 m (r=0.38) and 10-20 m (r=0.45) sprint. Body mass was significantly correlated to 10 m spring (r=0.35) in the 13- to 14-year-olds, as well as 20 m (r=0.33) and 10-20 m (r=0.35) sprint in the 15- to 16-year-olds.Height and body mass were significantly correlated with sprint performance in 13- to 16-year-old male soccer players. However, the 10- to 12-year-olds showed no significant relationship between sprint performance and anthropometrics, except for a small correlation in 10-20 m sprint. This may be attributed to maturation, with large differences in body height and body mass due to different patterns in the growth spurt. The agility performance related to anthropometrics was insignificant apart from a moderate correlation in the 13- to 14-year-olds.
Sprint
Body height
Cite
Citations (44)
Background: Diversity in clinical practice may become a problem and increase the risk of errors. Several tools have been suggested to reduce this diversity and improve unification in clinical practice. These tools include the clinical pathway, clinical guidelines, and practice protocol. They have been proven effective. However, there are different barriers to their application. Methods and Data Analysis: A cross-sectional survey in the Eastern Province of the Kingdom of Saudi Arabia aimed to identify the availability of the clinical pathway, clinical guidelines, and practice protocol and their benefits, as well as barriers in their development and utilization. Both quantitative and qualitative analyses were used to evaluate the study results. Findings are presented as numbers and percentages. Results: Clinical pathway, clinical guidelines, and practice protocol are available to a large extent in the Eastern Province. The study showed some difficulties in the development and implementation of these tools, such as insufficient training and leader support. It also provided some suggestions to overcome these barriers. Conclusion: The availability of clinical pathway, clinical guidelines, and practice protocol has helped unify practice and reduce errors in the clinical setting. The barriers can be overcome by different solutions.
Clinical Practice
Guideline
Clinical Pathway
Cite
Citations (0)
Sprint
Positive correlation
Vertical jump
Cite
Citations (0)
Background Sprint performance in junior Australian football (AF) players has been shown to be a differentiating quality in ability level therefore developing sprint characteristics via sprint-specific training methods is an important aspect of their physical development. Assisted sprint training is one training method used to enhance sprint performance yet limited information exists on its effect on sprint force-velocity characteristics. Therefore, the main aim of this study was to determine the influence of a combined sprint training intervention using assisted and maximal sprint training methods on mechanical characteristics and sprint performance in junior Australian football players. Methods Upon completing familiarization and pre-testing, twenty-two male junior Australian football (AF) players (age 14.4 ± 0.3 years, body mass 58.5 ± 10.0 kg, and height 1.74 ± 0.08 m) were divided into a combined sprint training (CST) group (n = 14), and a maximal sprint training (MST) group (n = 8) based on initial sprint performance over 20-meters. Sprint performance was assessed during maximal 20-meter sprint efforts via a radar gun (36 Hz), with velocity-time data used to derive force-velocity characteristics and split times. All subjects then completed a 7-week in-season training intervention consisting of maximal sprinting (MST & CST groups) and assisted sprinting (CST only), along with their usual football specific exercises. Results Moderate to large pre-post within group effects (−0.65 ≤ ES ≥ 0.82. p ≤ 0.01) in the CST group for relative theoretical maximal force (F 0 ) and power (P max ) were reflected in improved sprint performance from 0–20 m, thereby creating a more force-oriented F-v profile. The MST group displayed statistically significant pre-post differences in sprint performance between 10–20 m only (ES = 0.18, p = 0.04). Moderate to high relative reliability was achieved across all sprint variables (ICC = 0.65–0.91), except for the force-velocity slope (S FV ) and decrement in ratio of forces (D RF ) which reported poor reliability (ICC = 0.41–0.44), while the CST group exceeded the pre-post minimal detectable change (MDC) in most sprint variables suggesting a ‘true change’ in performance across the intervention. Conclusion It is concluded that implementing a short-term, combined sprint training intervention consisting of assisted and maximal sprint training methods may enhance sprint mechanical characteristics and sprint performance to 20-meters in junior AF players.
Sprint
Football players
Cite
Citations (3)
Lack of benefit of warm up on prolonged intermittent-sprint performance has been proposed to be due to use of a pacing strategy by participants. To investigate this, twelve participants performed four cycle trials that consisted of either prolonged intermittent-sprint performance (80 min) or single-sprint performance (4 s), with or without a warm up. The first-sprint of intermittent-sprint performance was also assessed. No interaction effects (P > 0.05) were found between trials for intermittent-sprint performance for total work (J · kg(-1)), or percentage work and power decrement. Work done during the first-sprint of intermittent-sprint performance (no warm up) was less (P < 0.001) than the first-sprint of intermittent-sprint performance (warm up; effect size (ES) = 0.59) and both single-sprint trials (warm up and no warm up; ES = 0.91, 0.75, respectively). Peak power (W · kg(-1)) for single-sprint (warm up) was greater (P < 0.05) than single-sprint (no warm up), and the first-sprint of intermittent-sprint performance (warm up and no warm up). Warm up improved single-sprint performance and the first sprint of intermittent-sprint performance. Use of a pacing strategy probably resulted in similar intermittent-sprint performance between trials. These results suggest that team-sport players should perform a warm up at the start of a game or before substitution during a game.
Sprint
Cite
Citations (17)
Sprint
Team sport
Cite
Citations (0)
Aim: The purpose of the present study was to evaluate the relationships between sprint mechanical parameters and sprint performance among female soccer players at different skill levels. The second objective was to assess a potential differences in force-velocity profiles between players from higher and lower sport skill level. Materials and methods: Sixty-six female soccer players (age = 23.1 5.1 years) performed a 30-m sprint to assess sprint performance and mechanical variables. Speed was measured by radar technology for 5, 10, 20, and 30 m and was used to calculate the theoretical maximal velocity (V0), theoretical maximal horizontal force (F0), maximal horizontal power (Pmax), decrease in the ratio of horizontal to resultant force (DRF), and peak ratio of horizontal to resultant force (RFpeak). Results: Different force-velocity (F-V) profile parameters are determinants of sprint performance at various distances. RFpeak (r =-0.99), Pmax (r = -0.93), and F0 (r = 0.92) had the strongest associations with sprint performance at shorter (5-m) distances, while at longer (20-m) distances, V0 (r = -0.73), Pmax (r = -0.94), and RFpeak (r = -0.88) were largely associated with sprint performance. The players from higher sports skill level showed higher levels of F0, RFpeak, Pmax and time to 10 meter distance. Conclusion: The results of this study suggest that depending on sprint distance used for testing and training procedures in female soccer players, the most informative parameters are Pmax, RFpeak, F0, and V0. As the skill level in female soccer players increases, an increase in maximal theoretical horizontal force during sprinting can be observed.
Sprint
Cite
Citations (2)
With progress in medical knowledge and in the technology of medical care, the contents of medical practice have become increasingly complicated year by year. The protocol practice (clinical algorithms or scheduled care) has been experimentally employed as one of medical-practice systems aimed at providing better medical care and maintaining its high standards. In the protocol practice the criteria for decision-making, which are clinically employed, are precisely made up in advance so that practice will be performed systematically. The WHO has recommended this protocol practice as a medical-care system appropriate for realizing clinical experiments. In recent years a number of clinical studies have been born from the protocol practice and, thus, it has been considered to be a formula for conducting clinical experiments tolerant of scientific criticism. The protocol practice, however, since it is difficult to conduct smoothly, has not yet been settled. This study aims at considering what we should do to make the protocol practice system settled through the observation of pitfalls in the course of its application.
Clinical Practice
Medical practice
Medical care
Cite
Citations (0)
This study compared the sprint mechanical properties of female and different aged male top-level soccer players. A total of 14 adult females (FEM) and 115 different aged male field players, competing at German top levels, participated in this study. The males belonged to teams of under 12, 13, 14, 15, 17, 19, and 23 years (U 12–23) and professionals (PRO). All players were tested for a 30 m linear sprint. From timing gate derived sprint times, force-velocity and power-velocity relationships, as well as theoretical maximum running velocity, force, and power data were computed by an inverse dynamic approach applied to the center of mass. The approach was optimized for taking the starting time into account, which is a progress in the present research field, when aiming to compute sprint mechanical properties by different methodological approaches under field conditions. Sprint mechanical properties of FEM were lower than those of PRO. Compared to other age groups, sprint mechanical properties of FEM were similar to those of U 14 and U 15. An increase in sprint mechanical properties was found from U 12 to U 17. The study shows that sprint mechanical properties differ according to gender and age in top-level soccer players.
Sprint
Cite
Citations (29)
The objective was to analyze the changes in the horizontal force-velocity profile (HFVP) during the execution of repeated sprinting. Methods: Seventeen first-division Chilean soccer players completed a repeated sprint protocol consisting of eight sprints of 30 m with 25-s pauses between repetitions. The behavior of HFVP variables in each attempt was recorded from video recordings and analysis in the MySprint® application. Results: Differences (p < 0.05) were found between sprints in the following: time (T), starting from sprint 5 (F = 35.6; η2p = 0.69); theoretical maximum speed (V0), starting from sprint 4 (F = 29.3; η2p = 0.51); maximum power (PM), starting from sprint 5 (F = 17; η2p = 0.52); rate of decrease in force index produced at each step (DRF), starting from sprint 1 (F = 3.20; η2p = 0.17); and RF10, starting from sprint 1 (F = 15.5; η2p = 0.49). In comparison, F0 and RFpeak did not present any differences (p > 0.05). Conclusion: The HFVP variables more sensitive to the effects of fatigue induced by an RSA protocol are those associated with the production of force at high speeds, being V0, DRF, and Pmax, while those that contribute to the generation of force at the beginning of the sprint, F0 and RFpeak, do not present essential variations.
Sprint
Repeated measures design
Cite
Citations (6)