A new valid and reliable windtrainer VO2max protocol.

AIM: Maximal oxygen uptake (VO(2max)) cycling protocols usually require expensive laboratory ergometers where the athlete is unaccustomed to the cycling position. Recently, we developed a VO(2max) speed-ramped protocol with an indoor cycling simulator (Cateye Windtrainer WT) allowing cyclists to use their own bicycles during the VO(2max) test. The aim of this study was to test the validity of the WT protocol by comparing it with a traditional (TD) resistance-ramped protocol using an electronically braked ergometer. In addition, the retest reliability of the WT protocol was also determined. METHODS: Twenty experienced cyclists randomly completed 6 VO(2max) protocols consisting of one familiarization trial and two tests on the WT and TD protocols. RESULTS: There were minimal differences in maximal oxygen uptake values between protocols (WT 64.1+/-7.1, TD 63.3+/-7.4 mL/kg/min). The variability in the difference of the means between the two protocols was 0.8 mL/kg/min (95% confidence interval CI: -0.26-2.02), the coefficient of variation (CV) was 2.8% (95%CI: 2.2-4.2%) and the interclass correlation was r=0.94 (P<0.01; 95%CI: 0.86-0.98). The intratest difference within the WT protocol was 1.5% (95%CI: -1.9-5%), CV=5.3% (95%CI: 4.1-8%) and the retest correlation was r=0.81 (P<0.01; 95%CI: 0.57-0.92). CONCLUSION: The WT speed-ramped protocol is a valid and reliable method to assess VO(2max).

Canadian Cardiovascular Society Consensus Conference 2002: Management of heart disease in the elderly patient.

Cardiovascular disease is a major health issue for the elderly patient. Many diagnostic, therapeutic and ethical issues are specific for the the older adult with heart disease. The Canadian Cardiovascular Society 2002 Consensus Conference provides recommendations for the most frequently encountered cardiac problems in the elderly patient. A common theme of the recommendations is the need to apply the best evidence based medicine together with an assessment of frailty, comorbidity and quality of life. A major goal of the conference was to identify treatments that are not optimally used in the older patient.

An examination of the health profile, service use and care needs of older adults in residential care facilities.

Private, unregulated residential care facilities have become an increasingly important component of the continuum of housing and care for frail older adults in Canada. To date, this growing segment of the older population has received very little research attention. This study involved an in-depth examination of the functional/health profile, patterns of service use, and medical/care needs of a representative sample of 178 older adults in residential care facilities in the City of Ottawa. The results indicate great diversity in resident and facility profiles in this setting and confirm earlier impressions that special care units in the residential care sector have become increasingly close to being unlicensed pseudo-nursing homes. Despite the heavy burden of care, the evidence suggests that the care needs of the majority of residents are adequately met in the residential care environment. The results can inform future research, case finding, educational, and policy planning initiatives in this setting.

A comparison of peak power in the shoulder press and shoulder throw.

The ability to generate peak power is central for performance in many sports. Currently two distinct resistance training methods are used to develop peak power, the heavy weight/slow velocity and light weight/fast velocity regimes. When using the light weight/fast velocity power training method it was proposed that peak power would be greater in a shoulder throw exercise compared with a normal shoulder press. Nine males performed three lifts in the shoulder press and shoulder throw at 30% and 40% of their one repetition maximum (1RM). These lifts were performed identically, except for the release of the bar in the throw condition. A potentiometer attached to the bar measured displacement and duration of the lifts. The time of bar release in the shoulder throw was determined with a pressure switch. ANOVA was used to examine statistically significant differences where the level of acceptance was set at p < 0.05. Peak power was found to be significantly greater in the shoulder throw at 30% of 1 RM condition [F, (1, 23) = 2.325 p < 0.051 and at 40% of 1 RM [F, (1, 23) = 2.905 p < 0.05] compared to values recorded for the respective shoulder presses. Peak power was also greater in the 30% of 1 RM shoulder throw (510 +/- 103W) than in the 40% of 1 RM shoulder press (471 +/- 96W). Peak power was produced significantly later in the shoulder throw versus the shoulder press. This differing power reflected a greater bar velocity of the shoulder throw at both assigned weights compared with the shoulder press.

Seniors' decision making about pain management.

BACKGROUND: Musculoskeletal pain is a problem with which many seniors must contend, many on a daily basis. Little is known, however, of the self-care decisions that seniors make regarding the management and control of this pain. These decisions can influence in a significant manner the delivery of health care to seniors and their overall health and well-being. Purpose. The purpose of our exploratory-descriptive study was to investigate seniors' decision making regarding the management and control of musculoskeletal pain by gathering data about the context of decision making, the types of decisions seniors made, their decisional conflict and the resources they used in decision making. METHODS: Focus groups and a mail-back questionnaire were used. Data were gathered in 1997 from a convenience sample of 50 seniors in Canada who experienced musculoskeletal pain of a noteworthy nature. RESULTS: Findings revealed that participants made decisions within a context of ageing and the health and social consequences of advancing age. The types of decisions they made included to ignore their pain and to use distraction. They also used exercise, the application of heat and cold, and medications to manage pain. Decisional conflict was minimal and consultation with family and friends superseded that with professionals. CONCLUSIONS: This study contributed to knowledge of decision making in later life about health matters generally, and the management and control of pain specifically. Findings point to the resourcefulness of seniors with respect to self-care and decision making. Seniors want to make informed decisions. However, they need information about the risks and benefits of decisions.

Continuing education for staff in long-term care facilities: corporate philosophies and approaches.

The purpose of this study was to determine corporate philosophies of continuing education and approaches to meeting the learning needs of staff who strive to provide for the increasingly challenging care requirements of seniors who reside in long-term care facilities. In-depth interviews lasting approximately 1 hour were conducted with key informants at the administrative level from nine long-term care facilities. Content analysis revealed a commitment to continuing education for staff. While recognizing the importance of organizational responsibility for continuing education, administrators placed emphasis on the individual responsibility of staff. Learning needs were identified as affective, managerial, and physical in nature. Challenges to providing continuing education programs were derived from a general lack of fiscal and human resources. A variety of measures was suggested as important to supporting the continuing learning of staff. Implications of this study point to the need for long-term care facilities to incorporate into their strategic plans measures of ensuring continuing education as a basis for the ongoing competence and development of staff. In addition, there is a need for collaboration between long-term care facilities and other institutions of a long-term care, acute care, and educational nature in the development of strategies to operationalize a philosophy of continuing learning as a basis for the provision of optimal care to residents.

Family caregiving in long-term care facilities.

Family caregiving within institutional settings is a neglected area of research In an era of cost containment, more and more is being asked of families of institutionalized persons. This article presents the results of a study designed to investigate family caregiving following the admission of an elderly relative to a long-term care facility. Beginning with a brief summary of findings from previous research, the article reports on visiting and task performance by families within the long-term care facility. Continuing with descriptions of families' satisfaction with institutional care and their care-related learning needs, the article concludes with recommendations for policy and practice.

Prescription and nonprescription drug use among at-risk community-dwelling seniors in Ottawa-Carleton.

BACKGROUND: The Council on Aging Ottawa-Carleton conducted an evaluation study aimed at reducing the inappropriate use of medication by community-dwelling seniors. During a 17-month period from 1990 to 1992, 278 of 415 seniors consented to participate. All were new referrals to home care, all were 65 years of age or older and all were taking a minimum of six prescription medications. OBJECTIVE: To describe the patterns of prescription and nonprescription drug use among high risk elderly people living in the Ottawa-Carleton region. ANALYSIS: Descriptive statistics and logistic regression were used to explore relationships between the numbers of drugs (prescription and nonprescription), drug classes and drug subclasses, and sex, age and number of prescribing physicians. RESULTS: The top 10 prescription or nonprescription drugs taken by study participants were consistent among diseases and health problems most commonly found among the elderly. Comparisons by rank for subclasses of drugs indicated that eye, ear, nose and throat (EENT), and respiratory drugs were considerably more prevalent among males than females, while women took more hormones and anxiolytics, sedatives and hypnotics. Age also appeared to have an effect; the proportions of respiratory drugs and hormones decreased with age. In contrast, vitamins and EENT drugs were most prevalent among the oldest seniors. These findings were supported by the results of multivariate analyses. Having three or more prescribing doctors was positively associated with the use of laxatives. Findings from multivariate analyses indicated that for prescription drugs, the youngest age group was about four times more likely than the oldest age group to be taking at least eight drugs. For nonprescription drugs, the only statistically significant finding was that those with three or more doctors were twice as likely as those with one or two doctors to take at least one nonprescription drug.

Assessing the quality of newspaper medical advice columns for elderly readers.

BACKGROUND: Medical advice columns in newspapers can provide a valuable service by educating the general public about important health-related issues. However, these columns may be harmful if the advice or information given in them is incomplete, inappropriate or misleading. The objective of this study was to assess the safety and appropriateness of advice given to elderly readers of newspapers in medical advice columns. METHODS: Medical advice columns published in Canadian newspapers in 1995 were identified from a CD-ROM database. The articles that were selected were published in English and contained medical advice pertinent to elderly people about topics that could be found in a textbook of geriatric medicine. Fifty articles, randomly selected from the 109 articles that met these criteria, were independently assessed by 5 geriatricians. A scoring system was used to rate the ability to determine to which population the article applied, how well fact was distinguished from opinion, the degree to which critical issues were addressed, the safety and the appropriateness of the advice. When the kappa statistic for inter-rater agreement was 0.74 or less, a 2-stage Delphi process was used in an attempt to reach consensus. RESULTS: Agreement (kappa > 0.74) was eventually achieved for 232 (92.8%) of the 250 ratings. In 4 (8%) of the articles there was a high probability that the advice given could be applied to the wrong patient population; in 7 (14%) there was a high probability that opinion might be interpreted as fact; and in 11 (22%) the major critical issues were not identified. Of greatest concern, however, the advice in 25 (50%) of the articles was judged to be inappropriate, and in 14 (28%) advice may have been dangerous and potentially life-threatening. INTERPRETATION: Although medical advice columns have the potential to improve the health of elderly readers, a significant percentage of these articles contain inappropriate or even potentially dangerous advice.

Referral to specialized geriatric services. Which elderly people living in the community are likely to benefit?

PROBLEM BEING ADDRESSED: As the Canadian population ages, family physicians encounter increasing numbers of elderly people with medical, functional, psychological, and social difficulties. In the past two decades, most regions of Canada have developed systems of specialized geriatric services, available on a consultative basis, to assist family physicians evaluating and managing elderly patients with these difficulties. For many family physicians, however, it is often unclear which of their elderly patients are likely to benefit from referral to these geriatric services. OBJECTIVE OF PROGRAM: Using an interdisciplinary approach, specialized geriatric services seek to optimize health, maximize function, promote independence, and prevent or delay institutionalization of elderly people. Yet not all elderly people benefit from referral to specialized geriatric services. This article offers a clear and clinically practical framework to help family physicians identify elderly patients in their practices who are likely to benefit from referral to specialized geriatric services. MAIN COMPONENTS OF PROGRAM: By synthesizing previous work on the concept of frail elderly persons into a 2 x 2 matrix, the level and intensity of geriatric intervention most appropriate for different segments of the elderly population is clarified. CONCLUSIONS: Using the simple approach described in this article, family physicians should be able to use available geriatric resources easily and efficiently to optimize the health and function of their elderly patients.

The pharmacoeconomics of dementia therapies. Bringing the clinical, research and economic perspectives together.

Dementia has reached epidemic proportions. The large numbers of people affected and the major impact that this disease has on healthcare costs are still not fully appreciated by the general public, governments or healthcare providers. Prevalence rates are expected to continue to escalate because of the dramatic aging of the population in many nations. This could create serious economic problems for already strained healthcare systems around the world. Fortunately, medications suitable for widespread use appear to be on the horizon. As therapies are developed, it will be necessary to assess their impact on individuals, healthcare systems and societies. The latter two refer to pharmacoeconomic research, an area in which a careful examination of issues central to the design and interpretation of such analyses must now be undertaken. This article outlines the critical components in the application of pharmacoeconomic methodology to the field of dementia research. Specifically, the accuracy of a pharmacoeconomic study is affected by the prevalence data and the economic methodology used. The outcome measures used in efficacy, effectiveness and pharmacoeconomic studies must be carefully chosen to ensure that they are valid, reliable and sensitive to change. These measures must also be meaningful to patients, families and clinicians. In the future, dementia therapies may prevent, delay, cure or slow the progression of the disease, and may also help control symptoms. It is important to study the impact of these effects from the perspectives of the patient, family and society. Dementias are important in terms of the number of people affected and the degree of suffering experienced, as well as the considerable financial burdens placed on families and society. Pharmacoeconomic analyses will have a significant influence on healthcare decisions affecting people with dementia. To ensure that these future decisions are in the best interests of patients, families and society, clinical knowledge of dementias must be incorporated into the design of pharmacoeconomic studies. Collaboration between clinicians, researchers and economists is essential in assessing future pharmacotherapies for dementing illnesses.

Demographics, aging and health care: is there a crisis?

Will the aging of Canada's population bankrupt the health care system? In this issue (see pages 1555 to 1560) Dr. Marie Demers reports that the increase in physician service costs for elderly people in Quebec from 1982 to 1992 resulted primarily from increased utilization and only secondarily from the growth of the elderly population. In this editorial the author argues that the common perception that masses of elderly people will soon swamp the system deflects attention from the crucial issue of utilization. Although a wide range of interventions for elderly people have demonstrable benefits, more research is needed to ensure that intensified services, especially for elderly people in good health, are effective and well targeted. It is not the aging of our population that threatens to precipitate a financial crisis in health care, but a failure to examine and make appropriate changes to our health care system, especially patterns of utilization.

Heterogeneity of 5-fluorouracil radiosensitivity modulation in cultured mammalian cell lines.

There is ample evidence that 5-fluorouracil (5-FU) improves both local control and survival of a variety of gastrointestinal tumors when added to radiotherapy. However, the modulation of radiosensitivity by 5-FU is incompletely understood and some reports are apparently contradictory. Therefore, we have reevaluated the modulation of radiosensitivity by 5-FU in a variety of mammalian cells. HT-29 and WiDr (human colon adenocarcinoma), DU-145 (human prostate adenocarcinoma), V-79 (Chinese hamster lung fibroblast), and HeLa cell lines were maintained in exponential growth as monolayer cultures. Cell survival following treatment with drug and/or radiation was determined by colony formation assay. Radiation was delivered either alone; midway through a 1 hr exposure to 7-25 micrograms/ml 5-FU (pulse); or following initiation of 0.1-1.5 micrograms/ml 5-FU present throughout the entire incubation for assay of colony forming ability (continuous exposure). These 5-FU levels were selected to approximate those achieved in vivo in humans. The results indicate that mammalian cell lines may vary substantially insofar as modulation of their radiosensitivity by 5-FU is concerned. Radiosensitization, defined by reduction in D0, was observed for continuous exposure only in V-79, WiDr, and HT-29 cell lines, was observed for both pulse exposure and continuous exposure in DU-145, and was not present in HeLa cells. Radioenhancement, defined by reduction in n, was observed in V-79, WiDr, and HT-29 but not in the other cell lines. This effect, characterized by reduction in the shoulder portion of the curve, is naturally accompanied by a decrease of Dq. This indicates that mammalian cell lines may have different responses to radiosensitivity modulation by 5-FU. Though the cell lines may exhibit radiosensitivity by either alterations in the slope or shoulder of the cell survival curve, the mechanisms responsible for both the heterogeneity as well as the radiosensitization itself are completely unknown at this time. Insight into the mechanisms for both the heterogeneity and the radiosensitization will be important areas for further investigation.