Environmental challenges facing athletes, stakeholders and spectators at Paris 2024 Olympic and Paralympic Games: an evidence-based review of mitigation strategies and recommendations.

The upcoming Paris 2024 Olympic and Paralympic Games could face environmental challenges related to heat, air quality and water quality. These challenges will pose potential threats to athletes and impact thousands of stakeholders and millions of spectators. Recognising the multifaceted nature of these challenges, a range of strategies will be essential for mitigating adverse effects on participants, stakeholders and spectators alike. From personalised interventions for athletes and attendees to comprehensive measures implemented by organisers, a holistic approach is crucial to address these challenges and the possible interplay of heat, air and water quality factors during the event. This evidence-based review highlights various environmental challenges anticipated at Paris 2024, offering strategies applicable to athletes, stakeholders and spectators. Additionally, it provides recommendations for Local Organising Committees and the International Olympic Committee that may be applicable to future Games. In summary, the review offers solutions for consideration by the stakeholders responsible for and affected by the anticipated environmental challenges at Paris 2024.

Fluid and electrolyte balance following consumption of skimmed milk and a plant-based soya beverage at rest in euhydrated males.

PURPOSE: Cow's milk is one of the most hydrating beverages, but many individuals choose not to consume dairy in their diet due to intolerance, allergy, or dietary preference. Milk is commonly replaced with plant-based beverages, including soya which has the most comparable protein content, but little is known about their hydration potential. This study compared fluid and electrolyte balance responses between a soya beverage and skimmed cow's milk. METHODS: Ten healthy males [age 27 (6) y; body mass index 24.6 (2.3) kg/m2] completed two randomised counterbalanced trials, involving consuming 1000 mL water from approximately isocaloric amounts of skimmed cow's milk (MILK) or a sweetened soya beverage (SOYA), in four aliquots over 30 min in a euhydrated fasted state. Volume, specific gravity, and electrolyte (sodium, potassium, chloride) concentrations were determined in total-void urine samples collected pre-/post-beverage ingestion, and hourly for 180 min thereafter. Hunger, thirst, nausea and stomach fullness were rated proximal to urine samples. RESULTS: Total urine mass (MILK, 986 ± 254 g; SOYA, 950 ± 248 g; P = 0.435) and urine specific gravity (P = 0.156) did not differ between trials. Potassium balance was greater in SOYA 0-180 min post-beverage (P ≤ 0.013), whilst chloride balance was greater in MILK 0-120 min post-beverage (P ≤ 0.036). Sodium balance (P = 0.258), total electrolyte balance (P = 0.258), and subjective measures (P ≥ 0.139) were not different between trials. CONCLUSION: Replacing cow's milk with a soya beverage did not negatively impact fluid balance in healthy young males, making it a viable option for those who choose not to consume dairy in their diet.

Iterative assessment of a sports rehydration beverage containing a novel amino acid formula on water uptake kinetics.

PURPOSE: Rapid gastric emptying and intestinal absorption of beverages is essential for rapid rehydration, and certain amino acids (AA) may augment fluid delivery. Three sugar-free beverages, containing differing AA concentrations (AA + PZ), were assessed for fluid absorption kinetics against commercial sugar-free (PZ, GZ) and carbohydrate-containing (GTQ) beverages. METHODS: Healthy individuals (n = 15-17 per study) completed three randomised trials. Three beverages (550-600 mL) were ingested in each study (Study 1: AA + PZ [17.51 g/L AA], PZ, GZ; Study 2: AA + PZ [6.96 g/L AA], PZ, GZ; Study 3: AA + PZ [3.48 g/L AA], PZ, GTQ), containing 3.000 g deuterium oxide (D2O). Blood samples were collected pre-, 2-min, 5-min, and every 5-min until 60-min post-ingestion to quantify maximal D2O enrichment (Cmax), time Cmax occurred (Tmax) and area under the curve (AUC). RESULTS: Study 1: AUC (AA + PZ: 15,184 ± 3532 δ‰ vs. VSMOW; PZ: 17,328 ± 3153 δ‰ vs. VSMOW; GZ: 17,749 ± 4204 δ‰ vs. VSMOW; P ≤ 0.006) and Tmax (P ≤ 0.005) were lower for AA + PZ vs. PZ/GZ. Study 2: D2O enrichment characteristics were not different amongst beverages (P ≥ 0.338). Study 3: Cmax (AA + PZ: 440 ± 94 δ‰ vs. VSMOW; PZ: 429 ± 83 δ‰ vs. VSMOW; GTQ: 398 ± 81 δ‰ vs. VSMOW) was greater (P = 0.046) for AA + PZ than GTQ, with no other differences (P ≥ 0.106). CONCLUSION: The addition of small amounts of AA (3.48 g/L) to a sugar-free beverage increased fluid delivery to the circulation compared to a carbohydrate-based beverage, but greater amounts (17.51 g/L) delayed delivery.

Perceived dehydration impairs endurance cycling performance in the heat in active males.

Dehydration of >3 % body mass impairs endurance performance irrespective of the individual's knowledge of their hydration status, but whether knowledge of hydration status influences performance at lower levels of dehydration is unknown. This study examined whether perception of hydration status influenced endurance performance. After familiarisation, nine active males (age 25 ± 2 y, V̇O2peak 52.5 ± 9.1 mL kg min-1) completed two randomised trials at 34 °C. Trials involved an intermittent exercise preload (8 × 10 min cycling/5 min rest), followed by a 15 min all-out cycling performance test. During the preload in both trials, water was ingested orally every 10 min (0.3 mL kg body mass-1), with additional water infused into the stomach via gastric feeding tube to produce dehydration of ∼1.5 % body mass pre-performance test. Participants were told intra-gastric infusion was manipulated to produce euhydration (0 % dehydration; Perceived-EUH) or dehydration (2 % dehydration; Perceived-DEH) pre-performance test, which was told to them pre-preload and confirmed after body mass measurement pre-performance test. Body mass loss during the preload (Perceived-EUH 1.6 ± 0.2 %, Perceived-DEH 1.7 ± 0.2 %; P = 0.459), heart rate, gastrointestinal temperature and RPE (P ≥ 0.110) were not different between trials. Thirst was greater at the end of the preload and performance test in Perceived-DEH (P ≤ 0.040). Work completed during the performance test was 5.6 ± 6.1 % lower in Perceived-DEH (187.4 ± 37.0 kJ vs. 176.9 ± 36.0 kJ; P = 0.038). These results suggest that at lower levels of dehydration (<2 % body mass), an individual's perception of their hydration status could impair their performance, as well as their thirst perception.

Hypohydration induced by prolonged cycling in the heat increases biomarkers of renal injury in males.

PURPOSE: Recent studies have shown that hypohydration can increase renal injury. However, the contribution of hypohydration to the extent of renal injury is often confounded by exercise induced muscle damage. Therefore, the aim of the present study was to investigate the effect of manipulating hydration status during moderate-intensity cycling in the heat on biomarkers of renal injury. METHODS: Following familiarisation, fourteen active males (age: 21 [20-22] y; BMI: 22.1 ± 1.9 kg/m2; V ˙ O2peak: 55 ± 9 mL/kg/min) completed two experimental trials, in a randomised cross-over design. Experimental trials consisted of up to 120 min of intermittent cycling (~ 50% Wpeak) in the heat (~ 35 °C, ~ 50% relative humidity). During exercise, subjects consumed either a water volume equal to 100% body mass losses (EU) or minimal water (HYP; 75-100 mL) to induce ~ 3% body mass loss. Blood and urine samples were collected at baseline, 30 min post-exercise and 24 h post-baseline, with an additional urine sample collected immediately post-exercise. RESULTS: Thirty minutes post-exercise, body mass and plasma volume were lower in HYP than EU (P < 0.001), whereas serum and urine osmolality (P < 0.001), osmolality-corrected urinary kidney injury molecule-1 concentrations (HYP: 2.74 [1.87-5.44] ng/mOsm, EU: 1.15 [0.84-2.37] ng/mOsm; P = 0.024), and percentage change in osmolality-corrected urinary neutrophil gelatinase-associated lipocalin concentrations (HYP: 61 [17-141] %, EU: 7.1 [- 4 to 24] %; P = 0.033) were greater in HYP than EU. CONCLUSION: Hypohydration produced by cycling in the heat increased renal tubular injury, compared to maintaining euhydration with water ingestion.

A self-paced 15-minute cycling time trial is a reliable performance measure in recreationally active individuals.

Cycling time trial (TT) protocols have been shown to be reliable in trained cyclists, but their reproducibility in lesser-trained individuals is unknown. This study examined the reliability of a self-paced 15-minute cycling TT in recreationally active individuals. Twelve recreationally active males (age 27 ± 3 y; body mass 75.2 ± 8.9 kg; V˙O2peak = 51.10 ± 7.53 ml∙kg∙min-1) completed a V˙O2peak test and four experimental trials, separated by > 48 h. Experimental trials consisted of 10 min cycling at 60% Wmax, followed by a self-paced 15-min TT. Heart rate and work done were recorded every 5 min during the TT; and coefficient of variation (CV) was calculated. Work done was not different (P = 0.706) between trials (193.2 ± 45.3 kJ; 193.2 ± 43.5 kJ; 192.0 ± 42.3 kJ; 193.9 ± 42.8 kJ). Within participant CV ranged from 0.5-4.9% for the four TTs, with a mean CV of 2.1%. Mean CV decreased from 2.0% (range 0.1-5.0%) for the first two TTs to 1.7% (range 0.2-5.6%) for the second and third TTs, and further decreased to 1.0% (range 0.2-1.8%) for the third and fourth TTs. In conclusion, the use of a short-duration self-paced cycling TT in recreationally active individuals is a reliable performance measure.

Exercise-induced hypohydration impairs 3 km treadmill-running performance in temperate conditions.

Research assessing exercise-induced hypohydration on running performance in a temperate environment is scarce. Given the weight-bearing nature of running, the negative effects of hypohydration might be offset by the weight-loss associated with a negative fluid balance. Therefore, this study investigated the effect of exercise-induced hypohydration on running performance in temperate conditions. Seventeen intermittent games players (age 22 ± 1 y; VO2peak 52.5 ± 4.1 mL∙kg-1∙min-1) completed preliminary and familiarisation trials, and two experimental trials consisting of 12 blocks of 6 min of running (65% VO2peak; preload) with 1 min passive rest in-between, followed by a 3 km time trial (TT). During the preload, subjects consumed minimal fluid (60 mL) to induce hypohydration (HYP) or water to replace 95% sweat losses (1622 ± 343 mL; EUH). Body mass loss (EUH -0.5 ± 0.3%; HYP -2.2 ± 0.4%; P < 0.001), and other changes indicative of hypohydration, including increased serum osmolality, heart rate, thirst sensation, and decreased plasma volume (P ≤ 0.022), were apparent in HYP by the end of the preload. TT performance was ~6% slower in HYP (EUH 900 ± 87 s; HYP 955 ± 110 s; P < 0.001). Exercise-induced hypohydration of ~2% body mass impaired 3 km running TT performance in a temperate environment.

Characterising consumer engagement in virtual models of care: A systematic review and narrative synthesis.

BACKGROUND: Widespread adoption of digital tools and technologies now support the delivery of virtual healthcare. Although, consumer engagement is central to care processes in virtual care models, there is paucity of evidence regarding the nature and outcomes of consumer engagement. This study aimed to determine the nature of consumer engagement used in virtual models of care, and its impact on quality and safety of care. METHODS: A systematic review was undertaken with a narrative synthesis, with a search strategy applied to five electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Web of Science) RESULTS: Fifty-eight studies were included in the review that utilised a variety of virtual models of care across care services. Consumer engagement, such as patients' active involvement in monitoring, capturing and reporting their health data, was a common feature of the identified virtual models. CONCLUSION: Increasing use of virtual models of care requires consideration of the role of patients and their support persons in the use of technology and in wider care processes that occur at a distance from health professionals. Ensuring consumers are equipped with necessary support to effectively engage in virtual care is important to ensure equity in access to, and outcomes of, virtual care models.

Post-exercise rehydration: Comparing the efficacy of three commercial oral rehydration solutions.

Introduction: This study compared the efficacy of three commercial oral rehydration solutions (ORS) for restoring fluid and electrolyte balance, after exercise-induced dehydration. Method: Healthy, active participants (N = 20; ♀ = 3; age ∼27 y, V˙O2peak ∼52 ml/kg/min) completed three randomised, counterbalanced trials whereby intermittent exercise in the heat (∼36°C, ∼50% humidity) induced ∼2.5% dehydration. Subsequently, participants rehydrated (125% fluid loss in four equal aliquots at 0, 1, 2, 3 h) with a glucose-based (G-ORS), sugar-free (Z-ORS) or amino acid-based sugar-free (AA-ORS) ORS of varying electrolyte composition. Urine output was measured hourly and capillary blood samples collected pre-exercise, 0, 2 and 5 h post-exercise. Sodium, potassium, and chloride concentrations in urine, sweat, and blood were determined. Results: Net fluid balance peaked at 4 h and was greater in AA-ORS (141 ± 155 ml) and G-ORS (101 ± 195 ml) than Z-ORS (-47 ± 208 ml; P ≤ 0.010). Only AA-ORS achieved positive sodium and chloride balance post-exercise, which were greater for AA-ORS than G-ORS and Z-ORS (P ≤ 0.006), as well as for G-ORS than Z-ORS (P ≤ 0.007) from 1 to 5 h. Conclusion: when provided in a volume equivalent to 125% of exercise-induced fluid loss, AA-ORS produced comparable/superior fluid balance and superior sodium/chloride balance responses to popular glucose-based and sugar-free ORS.

Ad-libitum fluid intake was insufficient to achieve euhydration 20 h after intermittent running in male team sports athletes.

This study documented 20 h rehydration from intermittent running while concealing the primary outcome of rehydration from subjects. Twenty-eight male team sports athletes (age 25 ± 3 y; predicted V̇O2max 54 ± 3 mL kg-1 min-1) were pair-matched to exercise (EX) or rest (REST) groups. To determine hydration status, body mass, urine and blood samples were collected at 08:00, pre-intervention (09:30), post-intervention (12:00), 3 h post-intervention and 08:00 the following morning (20 h). The intervention was 110 min intermittent running (EX) or seated rest (REST), with ad-libitum fluid provided in both. Subjects completed a weighed diet record and collected all urine for the 24 h. Changes typical of hypohydration were apparent in EX following the intervention period (body mass: EX -2.0 ± 0.5%; REST -0.2 ± 0.3%; serum osmolality: EX 293 ± 4 mOsm∙kgH2O-1; REST 287 ± 6 mOsm∙kgH2O-1; P ≤ 0.022). Fluid intake during the intervention period (EX 704 ± 286 mL, REST 343 ± 230 mL) and fluid intake within the first 3 h post-intervention (EX 1081 ± 460 mL, REST 662 ± 230 mL) were greater (P ≤ 0.004), and 24 h urine volume lower (EX 1697 ± 824 mL, REST 2370 ± 842 mL; P = 0.039) in EX. Compared to baseline, body mass remained lower (-0.6 ± 0.5%; P = 0.030) and urine osmolality elevated (20 h: 844 ± 197 mOsm∙kgH2O-1, 08:00: 698 ± 200 mOsm∙kgH2O-1; P = 0.004) at 20 h in EX. When games players drank fluid ad-libitum during exercise and post-exercise in free-living conditions, a small degree of hypohydration remained 20 h post-exercise.

Apple puree as a natural fructose source provides an effective alternative carbohydrate source for fuelling half-marathon running performance.

Carbohydrate supplementation during endurance exercise is known to improve performance, but the effects of food-based approaches in running exercise are understudied. Therefore, this study investigated the performance and gastrointestinal (GI) effects of a carbohydrate supplement containing a natural fructose source compared with a highly processed fructose source in a combined glucose-fructose supplement, during a half-marathon. Eleven trained runners (9 males, 2 females; age 32 ± 8 y, 89:53 ± 13:28 min half-marathon personal record) completed a familiarisation (8 miles) and two experimental trials (13.1 miles) on an outdoor running course, with blood and urine samples collected before and after the run. Subjective GI measures were made throughout the run. Carbohydrate was provided as a natural fructose source in the form of apple puree (AP) or highly processed crystalline fructose (GF) in a 2:1 glucose-to-fructose ratio (additional required glucose was provided through maltodextrin). Half-marathon performance was not different between carbohydrate sources (AP 89:52 ± 09:33 min, GF 88:44 ± 10:09 min; P = 0.684). There were no interaction effects for GI comfort (P = 0.305) or other GI symptoms (P ≥ 0.211). There were no differences between carbohydrate sources in ad libitum fluid intake (AP 409 ± 206 mL; GF 294 ± 149 mL; P = 0.094) or any other urinary (P ≥ 0.724), blood-based (P ≥ 0.215) or subjective (P ≥ 0.421) measures. Apple puree as a natural fructose source was equivalent to crystalline fructose in supporting half-marathon running performance without increasing GI symptoms.HighlightsResearch examining food-first and food-based approaches to carbohydrate supplementation and endurance running performance are limited. Therefore, this study aimed to compare carbohydrate supplements either containing a natural or highly processed fructose source as part of a glucose-fructose supplement on half-marathon running performance and gastrointestinal comfort in trained runners.Running performance (apple puree 89:52 ± 09:33 min vs. crystalline fructose 88:44 ± 10:09 min), gastrointestinal comfort and symptoms were not different between the two fructose sources.Apple puree can be effectively used as a carbohydrate source to fuel half-marathon running performance.

The impacts of sport emissions on climate: Measurement, mitigation, and making a difference.

As a global industry, sport makes potentially significant contributions to climate change through both carbon emissions and influence over sustainability practices. Yet, evidence regarding impacts is uneven and spread across many disciplines. This paper investigates the impacts of sport emissions on climate and identifies knowledge gaps. We undertook a systematic and iterative meta-analysis of relevant literature (1992-2022) on organized and individual sports. Using a defined search protocol, 116 sources were identified that map to four sport-related themes: (1) carbon emissions and their measurement; (2) emissions control and decarbonization; (3) carbon sinks and offsets; and (4) behavior change. We find that mega sport events, elite sport, soccer, skiing, and golf have received most attention, whereas grass-roots and women's sport, activity in Africa and South America, cricket, tennis, and volleyball are understudied. Other knowledge gaps include carbon accounting tools and indicators for smaller sports clubs and active participants; cobenefits and tradeoffs between mitigation-adaptation efforts in sport, such as around logistics, venues, sports equipment, and facilities; geopolitical influence; and scope for climate change litigation against hosts and/or sponsors of carbon-intensive events. Among these, researchers should target cobenefits given their scope to deliver wins for both climate mitigation and risk management of sport.

A Food First Approach to Carbohydrate Supplementation in Endurance Exercise: A Systematic Review.

This systematic review analyzed whether carbohydrate source (food vs. supplement) influenced performance and gastrointestinal (GI) symptoms during endurance exercise. Medline, SPORTDiscus, and citations were searched from inception to July 2021. Inclusion criteria were healthy, active males and females aged >18 years, investigating endurance performance, and GI symptoms after ingestion of carbohydrate from a food or supplement, <60 min before or during endurance exercise. The van Rosendale scale was used to determine risk of bias, with seven studies having low risk of bias. A total of 151 participants from 15 studies were included in the review. Three studies provided 0.6-1 g carbohydrate/kg body mass during 5-45 min precycling exercise (duration 60-70 min) while 12 studies provided 24-80 g/hr carbohydrate during exercise (60-330 min). Except one study that suggested a likely harmful effect (magnitude-based inferences) of a bar compared to a gel consumed during exercise on cycling performance, there were no differences in running (n = 1) or cycling (n = 13) performance/capacity between food and supplemental sources. Greater GI symptoms were reported with food compared with supplemental sources. Highly heterogenous study designs for carbohydrate dose and timing, as well as exercise protocol and duration, make it difficult to compare findings between studies. A further limitation results from only one study assessing running performance. Food choices of carbohydrate consumed immediately before and during endurance exercise result in similar exercise performance/capacity responses to supplemental carbohydrate sources, but may slightly increase GI symptoms in some athletes, particularly with exercise >2 hr.

Improving primary health care quality for refugees and asylum seekers: A systematic review of interventional approaches.

BACKGROUND: It has been widely acknowledged that refugees are at risk of poorer health outcomes, spanning mental health and general well-being. A common point of access to health care for the migrant population is via the primary health care network in the country of resettlement. This review aims to synthesize the evidence of primary health care interventions to improve the quality of health care provided to refugees and asylum seekers. METHODS: A systematic review was undertaken, and 55 articles were included in the final review. The Preferred Reporting Items for Systematic Reviews was used to guide the reporting of the review, and articles were managed using a reference-management software (Covidence). The findings were analysed using a narrative empirical synthesis. A quality assessment was conducted for all the studies included. RESULTS: The interventions within the broad primary care setting could be organized into four categories, that is, those that focused on developing the skills of individual refugees/asylum seekers and their families; skills of primary health care workers; system and/or service integration models and structures; and lastly, interventions enhancing communication services. Promoting effective health care delivery for refugees, asylum seekers and their families is a complex challenge faced by primary care professionals, the patients themselves and the communication between them. CONCLUSION: This review highlights the innovative interventions in primary care promoting refugee health. Primary care interventions mostly focused on upskilling doctors, with a paucity of research exploring the involvement of other health care members. Further research can explore the involvement of interprofessional team members in providing effective refugee/migrant health. PATIENT OR PUBLIC CONTRIBUTION: Patient and public involvement was explored in terms of interventions designed to improve health care delivery for the humanitarian migrant population, that is, specifically refugees and asylum seekers.

Hypohydration produced by high-intensity intermittent running increases biomarkers of renal injury in males.

PURPOSE: Whilst there is evidence to suggest that hypohydration caused by physical work in the heat increases renal injury, whether this is the case during exercise in temperate conditions remains unknown. This study investigated the effect of manipulating hydration status during high-intensity intermittent running on biomarkers of renal injury. METHODS: After familiarisation, 14 males (age: 33 ± 7 years; V̇O2peak: 57.1 ± 8.6 ml/kg/min; mean ± SD) completed 2 trials in a randomised cross-over design, each involving 6, 15 min blocks of shuttle running (modified Loughborough Intermittent Shuttle Test protocol) in temperate conditions (22.3 ± 1.0 °C; 47.9 ± 12.9% relative humidity). During exercise, subjects consumed either a volume of water equal to 90% of sweat losses (EU) or 75 mL water (HYP). Body mass, blood and urine samples were taken pre-exercise (baseline/pre), 30 min post-exercise (post) and 24 h post-baseline (24 h). RESULTS: Post-exercise, body mass loss, serum osmolality and urine osmolality were greater in HYP than EU (P ≤ 0.024). Osmolality-corrected urinary kidney injury molecule-1 (uKIM-1) concentrations were increased post-exercise (P ≤ 0.048), with greater concentrations in HYP than EU (HYP: 2.76 [1.72-4.65] ng/mOsm; EU: 1.94 [1.1-2.54] ng/mOsm; P = 0.003; median [interquartile range]). Osmolality-corrected urinary neutrophil gelatinase-associated lipocalin (uNGAL) concentrations were increased post-exercise (P < 0.001), but there was no trial by time interaction effect (P = 0.073). CONCLUSION: These results suggest that hypohydration produced by high-intensity intermittent running increases renal injury, compared to when euhydration is maintained, and that the site of this increased renal injury is at the proximal tubules.

Do patient engagement interventions work for all patients? A systematic review and realist synthesis of interventions to enhance patient safety.

BACKGROUND: Patients are increasingly being asked for feedback about their healthcare and treatment, including safety, despite little evidence to support this trend. This review identifies the strategies used to engage patients in safety during direct care, explores who is engaged and determines the mechanisms that impact effectiveness. METHODS: A systematic review was performed of seven databases (CINAHL, Cochrane, Cochrane-Central, Embase, ISI Web of Science, Medline, PsycINFO) that included research published between 2010 and 2020 focused on patient engagement interventions to increase safety during direct care and reported using PRISMA. All research designs were eligible; two reviewers applied criteria independently to determine eligibility and quality. A narrative review and realist synthesis were conducted. RESULTS: Twenty-six papers reporting on twenty-seven patient engagement strategies were included and classified as consultation (9), involvement (7) and partnership (11). The definitions of 'patient engagement' varied, and we found limited details about participant characteristics or interactions between people utilizing strategies. Collaborative strategy development, a user-friendly design, proactive messaging and agency sponsorship were identified as mechanisms to improve engagement about safety at the point of direct care. CONCLUSIONS: Agency sponsorship of collaboration between staff and patients is essential in the development and implementation of strategies to keep patients safe during direct care. Insufficient details about participant characteristics and patient-provider interactions limit recommendations for practice change. More needs to be learned about how patients are engaged in discussions about safety, particularly minority groups unable to engage with standard information. PATIENT OR PUBLIC CONTRIBUTION: Review progress was reported to the CanEngage team, including the consumer steering group, to inform project priorities (PROSPERO CRD42020196453).

Where Do Models for Change Management, Improvement and Implementation Meet? A Systematic Review of the Applications of Change Management Models in Healthcare.

BACKGROUND: The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets. Whilst a multitude of change management methodologies exist, their application in complex healthcare contexts remains unclear. Our review sought to establish the methodologies applied, and the nature and effectiveness of their application in the context of healthcare. METHODS: A systematic review and narrative synthesis was undertaken. Two reviewers independently screened the titles and abstracts followed by the full-text articles that were potentially relevant against the inclusion criteria. An appraisal of methodological and reporting quality of the included studies was also conducted by two further reviewers. RESULTS: Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. The most commonly applied methodologies were Kotter's Model (19 studies) and Lewin's Model (11 studies). Change management methodologies were applied in projects at local ward or unit level (14), institutional level (12) and system or multi-system (6) levels. The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches. CONCLUSION: Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.

Clinicians' experience of providing care: a rapid review.

BACKGROUND: Health care services internationally are refocussing care delivery towards patient centred, integrated care that utilises effective, efficient and innovative models of care to optimise patient outcomes and system sustainability. Whilst significant efforts have been made to examine and enhance patient experience, to date little has progressed in relation to provider experience. This review aims to explore this knowledge gap by capturing evidence of clinician experience, and how this experience is defined and measured in the context of health system change and innovation. METHODS: A rapid review of published and grey literature review was conducted utilising a rapid evidence assessment methodology. Seventy-nine studies retrieved from the literature were included in the review. Fourteen articles were identified from the grey literature search and one article obtained via hand searching. In total, 94 articles were included in the review. This study was commissioned by and co-designed with the New South Wales, Ministry of Health. RESULTS: Clinician experience of delivering health care is inconsistently defined in the literature, with identified articles lacking clarity regarding distinctions between experience, engagement and work-related outcomes such as job satisfaction. Clinician experience was commonly explored using qualitative research that focused on experiences of discrete health care activities or events in which a change was occurring. Such research enabled exploration of complex experiences. In these contexts, clinician experience was captured in terms of self-reported information that clinicians provided about the health care activity or event, their perceptions of its value, the lived impacts they experienced, and the specific behaviours they displayed in relation to the activity or event. Moreover, clinician's experience has been identified to have a paucity of measurement tools. CONCLUSION: Literature to date has not examined clinician experience in a holistic sense. In order to achieve the goals identified in relation to value-based care, further work is needed to conceptualise clinician experience and understand the nature of measurement tools required to assess this. In health system application, a broader 'clinician pulse' style assessment may be valuable to understand the experience of clinical work on a continuum rather than in the context of episodes of change/care.

The safety of health care for ethnic minority patients: a systematic review.

INTRODUCTION: Evidence to date indicates that patients from ethnic minority backgrounds may experience disparity in the quality and safety of health care they receive due to a range of socio-cultural factors. Although heightened risk of patient safety events is of key concern, there is a dearth of evidence regarding the nature and rate of patient safety events occurring amongst ethnic minority consumers, which is critical for the development of relevant intervention approaches to enhance the safety of their care. OBJECTIVES: To establish how ethnic minority populations are conceptualised in the international literature, and the implications of this in shaping of our findings; the evidence of patient safety events arising among ethnic minority healthcare consumers internationally; and the individual, service and system factors that contribute to unsafe care. METHOD: A systematic review of five databases (MEDLINE, PUBMED, PsycINFO, EMBASE and CINAHL) were undertaken using subject headings (MeSH) and keywords to identify studies relevant to our objectives. Inclusion criteria were applied independently by two researchers. A narrative synthesis was undertaken due to heterogeneity of the study designs of included studies followed by a study appraisal process. RESULTS: Forty-five studies were included in this review. Findings indicate that: (1) those from ethnic minority backgrounds were conceptualised variably; (2) people from ethnic minority backgrounds had higher rates of hospital acquired infections, complications, adverse drug events and dosing errors when compared to the wider population; and (3) factors including language proficiency, beliefs about illness and treatment, formal and informal interpreter use, consumer engagement, and interactions with health professionals contributed to increased risk of safety events amongst these populations. CONCLUSION: Ethnic minority consumers may experience inequity in the safety of care and be at higher risk of patient safety events. Health services and systems must consider the individual, inter- and intra-ethnic variations in the nature of safety events to understand the where and how to invest resource to enhance equity in the safety of care. REVIEW REGISTRATION: This systematic review is registered with Research Registry: reviewregistry761.

Sports Drink Intake Pattern Affects Exogenous Carbohydrate Oxidation during Running.

PURPOSE: This study aimed to determine whether the pattern of carbohydrate sports drink ingestion during prolonged submaximal running affects exogenous carbohydrate oxidation rates and gastrointestinal (GI) comfort. METHODS: Twelve well-trained male runners (27 ± 7 yr; 67.9 ± 6.7 kg; V˙O2peak, 68 ± 7 mL·kg·min) completed two exercise trials of 100 min steady-state running at 70%V˙O2peak. In each of the trials, 1 L of a 10% dextrose solution, enriched with [U-C] glucose, was consumed as either 200 mL every 20 min (CHO-20) or 50 mL every 5 min (CHO-5). Expired breath and venous blood samples were collected at rest and every 20 min during exercise. Subjective scales of GI comfort were recorded at regular intervals. RESULTS: Average exogenous carbohydrate oxidation rates were 23% higher during exercise in CHO-20 (0.38 ± 0.11 vs 0.31 ± 0.11 g·min; P = 0.017). Peak exogenous carbohydrate oxidation was also higher in CHO-20 (0.68 ± 0.14 g·min vs 0.61 ± 0.14 g·min; P = 0.004). During exercise, total carbohydrate oxidation (CHO-20, 2.15 ± 0.47; CHO-5, 2.23 ± 0.45 g·min, P = 0.412) and endogenous carbohydrate oxidation (CHO-20, 1.78 ± 0.45; CHO-5, 1.92 ± 0.40 g·min; P = 0.148) were not different between trials. Average serum glucose (P = 0.952) and insulin (P = 0.373) concentrations were not different between trials. There were no differences in reported symptoms of GI comfort and stomach bloatedness (P > 0.05), with only 3% of reported scores classed as severe (≥5 out of 10). CONCLUSION: Ingestion of a larger volume of carbohydrate solution at less frequent intervals during prolonged submaximal running increased exogenous carbohydrate oxidation rates. Neither drinking pattern resulted in increased markers of GI discomfort to a severe level.