Leveraging Interdisciplinary Teams for Pre-Visit Planning to Improve Pneumococcal Immunization Rates Among Internal Medicine Subspecialty Practices.

BACKGROUND: Despite the ready availability of pneumococcal vaccines and recommendation of vaccination by Center for Disease Control and Prevention (CDC), the immunization rates among adults less than 65 years of age with chronic and immunocompromised conditions remain low. METHODS: This interventional (cohort) study aimed to improve the pneumococcal vaccination rate for patients with an increased risk of pneumococcal disease by utilizing a three-pronged approach. This included: (1) clinician education webinar, (2) pre-visit counseling performed by registered nurses, targeted toward patients with upcoming appointments, to address vaccination status, and (3) modified pre-visit interdisciplinary team huddle with clinicians and registered nurses to review which patients are amenable to vaccination at the time of visit and those who may benefit from re-engagement and further motivational interviewing. After the completion of the 10-week intervention, study organizers reviewed the percent of patients with completed pneumococcal vaccinations. RESULTS: In this 10-week rapid cycle initiative, a total of 482 patients were eligible for vaccination. During the intervention phase, 370 patients were contacted and of these 38% of patients were amenable to receiving a vaccine during the pre-visit counseling, 5% were previously vaccinated, 18% were not amenable, and 38% were unreachable prior to visit. This initiative resulted in a 43% increase in the vaccination rate in this cohort. CONCLUSIONS: The significant increase in vaccination rate supports the utilization of a framework in the multidisciplinary approach to pre-visit planning in non-primary care specialties and other vaccination efforts, especially emerging diseases such as COVID-19. Future directions of study include the efficacy of telemedicine counseling with a same-day appointment for vaccination, co-location of registered nurses within the practice sites, as well as the use of other ancillary staff (such as medical office assistants) to engage patients in pre-visit planning.

Glycemic effects following the consumption of mixed soy protein isolate and alginate beverages in healthy adults.

This study examined whether the consumption of beverages containing mixed soy protein isolate (SPI) and fiber, alginate (ALG), would affect postprandial glucose and insulin responses or appetite in healthy adults. Following an overnight fast, twelve healthy subjects were asked to consume six standardized breakfast beverages in a randomized order: a 122 kcal sugar beverage (CONT), a 122 kcal sugar beverage with ALG, a 172 kcal sugar beverage with SPI at pH 7 (SPI-7) or 6 (SPI-6), and a 172 kcal sugar beverage with mixed SPI and alginate at pH 7 (SPI + ALG-7) or 6 (SPI + ALG-6). Subjects consumed one of the beverages at time 0. Blood samples were drawn at -15, 0, 15, 30, 45, 60, 90 and 120 min and questionnaires were completed immediately following the blood drawing at each time point. The results showed that, compared to CONT, the consumption of SPI-7, SPI-6, SPI + ALG-7 and SPI + ALG-6 significantly lowered (P < 0.05) the peak plasma glucose concentration (33.4%, 36.3%, 53.2%, and 58.5%, respectively), 120 min incremental area under the curve (AUC), and peak insulin concentration. SPI + ALG-6 and SPI + ALG-7 exhibited a significant reduction in the peak glucose concentration compared to SPI without alginate (P < 0.05). No significant effect on appetite was found in any conditions. Electrostatic interactions between the protein and alginate during digestion and formation of intragastric gel could play an important role in influencing the postprandial glucose response. This study indicates that the consumption of mixed SPI and ALG beverages was the most effective in attenuating the postprandial glycemic excursion in healthy adult subjects.

Evaluating the Intervention-Based Evidence Surrounding the Causal Role of Breakfast on Markers of Weight Management, with Specific Focus on Breakfast Composition and Size.

Nutritional strategies are vitally needed to aid in the management of obesity. Cross-sectional and epidemiologic studies consistently demonstrate that breakfast consumption is strongly associated with a healthy body weight. However, the intervention-based long-term evidence supporting a causal role of breakfast consumption is quite limited and appears to be influenced by several key dietary factors, such as dietary protein, fiber, and energy content. This article provides a comprehensive review of the intervention-based literature that examines the effects of breakfast consumption on markers of weight management and daily food intake. In addition, specific focus on the composition and size (i.e., energy content) of the breakfast meal is included. Overall, there is limited evidence supporting (or refuting) the daily consumption of breakfast for body weight management and daily food intake. In terms of whether the type of breakfast influences these outcomes, there is accumulating evidence supporting the consumption of increased dietary protein and fiber content at breakfast, as well as the consumption of more energy during the morning hours. However, the majority of the studies that manipulated breakfast composition and content did not control for habitual breakfast behaviors, nor did these studies include a breakfast-skipping control arm. Thus, it is unclear whether the addition of these types of breakfast plays a causal role in weight management. Future research, including large randomized controlled trials of longer-term (i.e., ≥6 mo) duration with a focus on key dietary factors, is critical to begin to assess whether breakfast recommendations are appropriate for the prevention and/or treatment of obesity.

A high-protein breakfast prevents body fat gain, through reductions in daily intake and hunger, in "Breakfast skipping" adolescents.

OBJECTIVE: The purpose of this study was to examine whether the daily consumption of normal-protein (NP) vs. high-protein (HP) breakfast meals improves appetite control, food intake, and body composition in "breakfast skipping" young people with overweight/obesity. METHODS: Fifty-seven adolescents (age: 19 ± 1 years; BMI: 29.7 ± 4.6 kg m(-2)) completed a 12-week randomized controlled trial in which the adolescents consumed either a 1,464 kJ NP breakfast (13 g protein) or a HP breakfast (35 g protein) or continued to skip breakfast (CON). Pre- and post-study appetite, food intake, body weight, and body composition were assessed. RESULTS: Time-by-group interactions (P < 0.05) were detected for body fat mass, daily intake, and perceived hunger. Specifically, HP prevented fat mass gains over the 12 weeks (-0.4 ± 0.5 kg) vs. CON (+1.6 ± 0.9 kg; P = 0.02), whereas NP did not (+0.3 ± 0.5 kg). HP led to reductions in daily intake (-1,724 ± 954 kJ) vs. CON (+1,556 ± 745 kJ; P = 0.03), whereas NP did not (+494 ± 213 kJ). Lastly, only the HP group experienced reductions in daily hunger vs. CON (P < 0.05). However, when directly comparing the HP vs. NP groups, no differences were detected in any outcomes. CONCLUSIONS: The daily addition of a HP breakfast improved indices of weight management as illustrated by the prevention of body fat gain, voluntary reductions in daily intake, and reductions in daily hunger in breakfast skipping adolescents with overweight/obesity.

Consuming High-Protein Soy Snacks Affects Appetite Control, Satiety, and Diet Quality in Young People and Influences Select Aspects of Mood and Cognition.

BACKGROUND: Data concerning the effects of afternoon snacking on ingestive behavior, mood, and cognition are limited. OBJECTIVE: The purpose of this study was to compare 1088 kJ of high-protein (HP) or high-fat (HF) afternoon snacks vs. no snacking on appetite, food intake, mood, and cognition in adolescents. METHODS: Thirty-one healthy adolescents (age: 17 ± 1 y) consumed the following afternoon snacks (in randomized order) for 3 d: HP snack (26 g of protein/6 g of fat per 27 g of carbohydrates), HF snack (4 g of protein/12 g of fat per 32 g of carbohydrates), and no snack (NoS). On day 4 of each treatment, the participants completed an 8-h testing day containing pre- and postsnack appetite questionnaires, food cue-stimulated functional MRI brain scans, mood, cognitive function, and eating initiation. Ad libitum dinner and evening snacks were provided and assessed. RESULTS: HP, but not HF, delayed eating initiation vs. NoS (P < 0.05). Both snacks reduced appetite vs. NoS (P < 0.001) with HP eliciting greater reductions than HF (P < 0.05). Only HF led to reductions in corticolimbic activation in brain regions controlling food motivation/reward vs. NoS (P < 0.01). Although no treatment differences in daily energy intake were detected, HP led to greater protein consumption than NoS (P < 0.05) and greater protein and lower fat consumption than HF (both, P < 0.05). HP led to fewer HF/high-sugar evening snacks than NoS (P < 0.01) and HF (P = 0.09). Although no treatment effects were detected for mood and cognition, HP tended to reduce confusion-bewilderment (P = 0.07) and increase cognitive flexibility (P = 0.09), whereas NoS reduced tension-anxiety (P < 0.05) and vigor-activity (P < 0.05). CONCLUSION: Afternoon snacking, particularly on HP soy foods, improves appetite, satiety, and diet quality in adolescents, while beneficially influencing aspects of mood and cognition. This trial was registered at clinicaltrials.gov as NCT01781286.

Effects of lactate consumption on blood bicarbonate levels and performance during high-intensity exercise.

The authors sought to determine the effects of oral lactate consumption on blood bicarbonate (HCO(3)-) levels, pH levels, and performance during high-intensity exercise on a cycle ergometer. Subjects (N = 11) were trained male and female cyclists. Time to exhaustion (TTE) and total work were measured during high-intensity exercise bouts 80 min after the consumption of 120 mg/kg body mass of lactate (L), an equal volume of placebo (PL), or no treatment (NT). Blood HCO(3)- increased significantly after ingestion of lactate (p < .05) but was not affected in PL or NT (p > .05). No changes in pH were observed as a result of treatment. TTE and total work during the performance test increased significantly by 17% in L compared with PL and NT (p = .02). No significant differences in TTE and total work were seen between the PL and NT protocols (p = .85). The authors conclude that consuming 120 mg/kg body mass of lactate increases HCO(3)- levels and increases exercise performance during high-intensity cycling ergometry to exhaustion.

Comparison of power outputs during time trialing and power outputs eliciting metabolic variables in cycle ergometry.

The authors sought to compare power output at blood lactate threshold, maximal lactate steady state, and pH threshold with the average power output during a simulated 20-km time trial assessed during cycle ergometry. Participants (N = 13) were trained male and female cyclists and triathletes, all permanent residents at moderate altitude (1,525-2,225 m). Testing was performed at 1,525 or 1,860 m altitude. Power outputs were determined during a simulated 20-km time trial (PTT), at blood pH threshold (PpHT), at maximal lactate steady state (PMLSS), and at blood lactate threshold determined by 2 methods: the highest power output that did not result in consecutive and continued increases in blood lactate concentrations from exercising baseline (PLT) and the highest power output that did not result in consecutive and continued increases of > or =1 mmol/L in blood lactate concentrations from exercising baseline (PLT1). PLT, PLT1, and PMLSS were all significantly lower than PpHT (p < .05) and PTT (p < .05). No significant difference was observed between PpHT and PTT (p > .05). Significant correlations were observed between each of the metabolic variables, PLT, PLT1, PMLSS, and PpHT, compared with PTT (p < .05). The authors conclude that, of the 4 metabolic variables, only PpHT offered an accurate reflection of PTT.