Effects of food bar chewing duration on the physiologic, metabolic, and perceptual responses to moderate-intensity running.

PURPOSE: Chewing duration can affect food particle size, gastric processing, and postprandial glycemia, but these effects have not been investigated with exercise. This study examined how the chewing duration of a food bar impacts glycemic and metabolic responses, gastrointestinal (GI) symptoms, psychological affect, and performance during endurance running. METHODS: This randomized, unblinded, crossover study had 15 males (35.2 ± 7.4 years, VO2peak: 56.1 ± 5.2 ml/kg/min) attend three laboratory visits. Visit 1 required a VO2peak test, 10 min familiarization run at 60% VO2peak, and familiarization time-to-exhaustion (TTE) test (10 min at 90% VO2peak, followed by TTE at 100% VO2peak). Visits 2 and 3 consisted of a 60 min run at 60% VO2peak, followed by TTE testing. Participants were fed 45 g of a bar (180 kcal, 4 g fat, 33 g carbohydrate, 3 g protein, 1 g fiber) in 9 g servings 30 min before running, and 27 g of bar in 9 g servings at three timepoints during the 60 min run. Participants consumed the servings in 20 (20CHEW) or 40 (40CHEW) masticatory cycles, at 1 chew/second. Outcomes included blood glucose, substrate use, GI symptoms, perceived exertion (RPE), overall feeling, and TTE. RESULTS: Post-prandial blood glucose, GI symptoms, and RPE increased over time, but there were no significant between-condition or condition-by-time effects. TTE showed no significant between-condition effect (20CHEW: 288 ± 133 s; 40CHEW: 335 ± 299 s; p = 0.240). Overall feeling demonstrated a time-by-condition effect (p = 0.006), suggesting possible better maintenance over time with 40CHEW. CONCLUSION: Cumulatively, the results suggest that extended chewing minimally impacts physiology, perceptions, and performance during 60 min moderate-intensity running.

The association of moderate-to-vigorous and light-intensity physical activity on static balance in middle-aged and older-aged adults.

BACKGROUND: Falls are the leading cause of injury among adults ≥ 65 years of age. Participation in physical activity (PA) is associated with improved balance, though it is impact in the middle-age population is not well understood. AIM: The purpose of the current study was to examine the influence of PA intensity on static balance in middle-aged and older aged individuals. METHODS: Included were middle-aged adults (40-64 years) and older adults (≥ 65 years) from the 2003-2004 years of the National Health and Nutrition Evaluation Survey. Light physical activity (LPA) and moderate-vigorous physical activity (MVPA) were collected via accelerometer and static balance via the Romberg Test of Standing Balance. RESULTS: No significant odds ratio relationship was found between MVPA or LPA and having good static balance in the middle-aged population; 1.04 (95% CI 0.95, 1.13) p = 0.427 and 1.05 (95% CI 0.97, 1.14) p = 0.182, respectively. Whereas, in older adults, every 60-min increase in LPA was significantly associated with 28% higher odds of good balance (95% CI 1.15, 1.41; p < 0.001), and every 10-min increase in MVPA with 25% higher odds of good balance (95% CI 1.08, 1.45; p = 0.006). DISCUSSION: LPA and MVPA were not associated with good static balance in middle-aged adults, but in older adults LPA was significantly associated with good static balance. CONCLUSION: A significant relationship is found between age and fall risk, which is a major concern in the aging population.

Ammonia Inhalation Does Not Increase Deadlift 1-Repetition Maximum in College-Aged Male and Female Weight Lifters.

Vigil, JN, Sabatini, PL, Hill, LC, Swain, DP, and Branch, JD. Ammonia inhalation does not increase deadlift 1-repetition maximum in college-aged male and female weight lifters. J Strength Cond Res 32(12): 3392-3397, 2018-Ammonia inhalant use by powerlifters and weight lifters is a prevalent practice with little research support for improved performance. The purpose of this study was to investigate the effects of ammonia as a stimulant on athletic performance during a deadlift 1-repetition maximum (1RM) absolute strength test. Subjects (men: n = 10, mean ± SD age = 21 ± 1 year, mass = 72.5 ± 6.8 kg; and women: n = 10, age = 22 ± 5 years, mass = 66.2 ± 8.1 kg) were required to have at least 2 years of resistance training experience while lacking a history of asthma, lightheadedness, fainting, anaphylaxis, sickle cell traits, and other respiratory disorders. After a baseline 1RM test, subjects were paired by 1RM performance and gender, then randomly assigned in a counterbalanced treatment order to control (water) or ammonia trials after a minimum 72-hour recovery period for another 1RM test involving attempts at 100.0, 102.5, 105.0, and 107.5% of the established 1RM value. Testing was then repeated after the minimum rest period for the remaining trial. Results revealed the expected gender main effect for absolute deadlift 1RM (93.0 ± 29.5 [women]; 152.0 ± 29.5 kg [men]; p < 0.001), but no trial main effect (p = 0.874) or gender by trial interaction effect (baseline = 93.0 ± 15.3, 151.8 ± 42.3 kg; water = 92.0 ± 12.5, 150.9 ± 37.8 kg; ammonia = 92.5 ± 16.4, 153.4 ± 37.9 kg) for women and men, respectively (p = 0.559). Within the limitations of this study, there is no support for the practice of ammonia inhalation to improve deadlift 1RM in training or competition.

C57BL/6 mice are resistant to joint degeneration induced by whole-body vibration.

OBJECTIVE: Whole-body vibration (WBV) platforms are commercially available devices that are used clinically to treat numerous musculoskeletal conditions based on their reported ability to increase bone mineral density and muscle strength. Despite widespread use, there is an alarming lack of understanding of the direct effects of WBV on joint health. Previous work by our lab demonstrated that repeated exposure to WBV using protocols that model those used clinically, induces intervertebral disc (IVD) degeneration and osteoarthritis-like damage in the knee of skeletally mature, male mice of a single outbred strain (CD-1). The present study examined whether exposure to WBV induces similar deleterious effects in a genetically different strain of mouse (C57BL/6). DESIGN: Male 10-week-old C57BL/6 mice were exposed to vertical sinusoidal WBV for 30 min/day, 5 days/week, for 4 or 8 weeks using previously reported protocols (45 Hz, 0.3 g peak acceleration). Following WBV, joint tissues were examined using histological analysis and gene expression was quantified using real-time PCR (qPCR). RESULTS: Our analyses show a lack of WBV-induced degeneration in either the knee or IVDs of C57BL/6 mice exposed to WBV for 4 or 8 weeks, in direct contrast to the WBV-induced damage previously reported by our lab in CD-1 mice. CONCLUSIONS: Together with previous studies from our group, the present study demonstrates that the effects of WBV on joint tissues vary in a strain-specific manner. These findings highlight the need to examine genetic or physiological differences that may underlie susceptibility to the deleterious effects of WBV on joint tissues.

Autonomic response to tactical pistol performance measured by heart rate variability.

This study evaluated changes in autonomic tone during a tactical pistol competition. At rest and during a match, heart rate variability (HRV) was examined in 28 healthy subjects. Heart rate variability time-domain variables (including interbeat interval [IBI]) and frequency-domain variables (low frequency [LF], high frequency [HF], total power [TP]) measured during shooting were subtracted from those measured during rest to produce Δs. The shooting task involved several, rapid tactical maneuvers. Raw time to completion and inaccurate shots (points down [PDs]) were recorded and combined to form a match score where lower values indicated superior shooting performance. Mean (±SD) raw time was 135.9 ± 34.1 seconds, PDs were 78 ± 34, and match score was 175.3 ± 39.8. Shooting decreased IBI (i.e., increased heart rate) and LF. ΔLF, ΔHF, and ΔTP were independent of ΔIBI. Raw time was significantly (p ≤ 0.05) correlated to shooting IBI (r = 0.404) and ΔIBI (r = -0.426). Points down were significantly correlated to ΔTP (r = 0.416) and ΔLF (r = 0.376). Match score was significantly correlated to ΔIBI (r = -0.458), ΔHF (r = 0.467), ΔLF (r = 0.377), and ΔTP (r = 0.451). In conclusion, individuals with a greater decrease in IBI (and thus heart rate) performed better by accomplishing the match faster. Individuals with less change in stress-related HRV measures (LF, HF, and TP) performed better through improved accuracy. Thus, HRV-derived sympathetic response is significantly related to shooting performance and should be used to assess marksmanship effectiveness under duress.

A tendon graft weave using an acellular dermal matrix for repair of the Achilles tendon and other foot and ankle tendons.

Many techniques are available to repair tendon ruptures of the Achilles tendon as well as other foot and ankle tendons. The purpose of this article was to present a technique of tendon repair that is a combination of a tendon graft inlay with a Pulvertaft-type tendon weave using an acellular human dermal matrix graft with a resultant "strip and shoelace." A description of the technique, along with 3 case reports, is included. Tendon donor site morbidity problems associated with tendon transfer procedures are avoided by use of this dermal matrix weave. This procedure is felt to have enhanced strength with less bulk than soft tissue graft wrap procedures.

Functional performance following an ice bag application to the hamstrings.

This study examined the immediate and short-term (20 minute) effects of 3- and 10-minute ice bag applications to the hamstrings on functional performance as measured by the cocontraction test, shuttle run, and single-leg vertical jump. Forty-two (25 women, 17 men) recreational or collegiate athletes who were free of injury in the lower extremity 6 months before testing and who did not suffer from allergy to cryotherapy were included. Time to completion was measured in seconds for the cocontraction and the shuttle run test. Single-leg vertical jump was measured on the Vertec (Sports Imports, Columbus, Ohio) in centimeters. The 10-minute ice bag application reduced immediate post-application vertical jump performance and increased immediate post and 20-minute post shuttle run time (p

Effect of creatine supplementation on cycle ergometer exercise in a hyperthermic environment.

In order to examine thermoregulatory response to creatine (CR) supplementation, competitive male cyclists and triathletes (n = 7, VO2max = 50.6 +/- 0.8 ml x kg(-1) x min(-1)) completed three 1-hour hyperthermic (ambient temperature = 38.7 +/- 1.0 degrees C, relative humidity = 33 +/- 4%) exercise sessions at 181 +/- 12 W (50% of Wmax, approximately 66% of VO2max). Subjects completed a baseline (BL) session, then 2 sessions following 5 days of CR (20 g x d(-1)) and placebo (PL, 20 g x d(-1)) administered in a double-blind counterbalanced crossover manner with > or = 28-day washout. Pre-exercise BL, CR, and PL body mass were unchanged, with similar decreases in postexercise mass among the three conditions. Tympanic temperature, heart rate, systolic blood pressure, perceived exertion, and lactate, cortisol, and aldosterone concentrations increased similarly during BL, CR, and PL exercise. A greater (p = 0.013) estimated decrease in plasma volume occurred following BL (-16.5 +/- 2.0%) and PL (-17.6 +/- 1.7%) exercise compared to CR (-13.5 +/- 2.1%). Creatine supplementation reduces plasma volume loss during 1 hour of hyperthermic exercise but does not appear to otherwise change thermoregulatory response to hyperthermic exercise.

Adrenal cortical carcinoma metastatic to the breast.

A 56 year old woman was diagnosed with adrenal cortical carcinoma in May 2003, for which she underwent left radical adrenalectomy. Eight months later, in January 2004, she presented with a solitary, well delineated, left breast mass with central pleomorphic calcifications on mammographic examination. A diagnosis of metastatic adrenal cortical carcinoma was made on core biopsy. Subsequently, the patient underwent a lumpectomy of the mass, which confirmed the diagnosis. To our knowledge, this is the first case report of adrenal cortical carcinoma metastatic to the breast.

Response of T lymphocytes from previously infected calves to recombinant Cryptosporidium parvum P23 vaccine antigen.

We had previously demonstrated that a Type-1-like immune response involving interferon-gamma expression in lamina propria lymphocytes accompanied by IgG2 subclass fecal antibodies to Cryptosporidium parvum p23 emerged in gut mucosa of calves recovering from cryptosporidiosis. Because a recombinant p23 had been shown to protect calves from cryptosporidiosis when administered as a vaccine antigen to late gestation cattle, this study was undertaken to determine if the same vaccine antigen could induce a Type-1-like, in vitro response by T cells from calves that had recovered from C. parvum infection. We isolated peripheral blood mononuclear cells from calves that had been previously infected with C. parvum oocysts and incubated them in the presence or absence of the recombinant C. parvum p23 vaccine antigen. We used flow cytometry to simultaneously detect cells in cell cycle and identify the T cell subset containing cycling cells. We also used flow cytometry to identify interferon-gamma positive cells and 2-dimensional gel electrophoresis to profile proteins made by PBMC stimulated with the recombinant p23 vaccine antigen. The results demonstrated that CD4+ T lymphocytes proliferated and that interferon-gamma was synthesized by a subset of stimulated cells. Two-dimensional gel electrophoresis revealed the presence of several cytoplasmic proteins in a size range of approximately 25-80 kDa that were detected in p23-stimulated, but not in unstimulated, cytoplasmic samples. Together, the results show that the recombinant p23 vaccine antigen can stimulate a Type-1-like immune response by T cells from calves that have recovered from C. parvum infection.

Validation of a new method for estimating VO2max based on VO2 reserve.

PURPOSE: The American College of Sports Medicine's (ACSM) preferred method for estimating maximal oxygen consumption (VO2max) has been shown to overestimate VO2max, possibly due to the short length of the cycle ergometry stages. This study validates a new method that uses a final 6-min stage and that estimates VO2max from the relationship between heart rate reserve (HRR) and VO2 reserve. METHODS: A cycle ergometry protocol was designed to elicit 65-75% HRR in the fifth and sixth minutes of the final stage. Maximal workload was estimated by dividing the workload of the final stage by %HRR. VO2max was then estimated using the ACSM metabolic equation for cycling. After the 6-min stage was completed, an incremental test to maximal effort was used to measure actual VO2max. Forty-nine subjects completed a pilot study using one protocol to reach the 6-min stage, and 50 additional subjects completed a modified protocol. RESULTS: The pilot study obtained a valid estimate of VO2max (r = 0.91, SEE = 3.4 mL x min(-1) x kg-1) with no over- or underestimation (mean estimated VO2max = 35.3 mL x min(-1) x kg(-1), mean measured VO2max = 36.1 mL x min(-1) x kg(-1)), but the average %HRR achieved in the 6-min stage was 78%, with several subjects attaining heart rates considered too high for submaximal fitness testing. The second study also obtained a valid estimate of VO2max (r = 0.89, SEE = 4.0 mL x min(-1) x kg(-1)) with no over- or underestimation (mean estimated VO2max = 36.7 mL x min(-1) x kg(-1), mean measured VO2max = 36.9 mL x min(-1) x kg(-1), and the average %HRR achieved in the 6-min stage was 64%. CONCLUSIONS: A new method for estimating VO2max from submaximal cycling based on VO2 reserve has been found to be valid and more accurate than previous methods.

Childhood obesity's relationship to time spent in sedentary behavior.

OBJECTIVE: The purpose of this study was to evaluate various types of sedentary behavior children participate in and to look for an association to childhood obesity. METHODS: Questionnaires were used to gather data on physical and sedentary activity, dietary intake, demographics, and anthropometrics of 9- to 12-year-old military dependents and their parents. RESULTS: Using body mass index (BMI), 39.8% of children were obese. A significant relationship was found between childhood obesity and computer usage, television watching, total hours in sedentary behavior, and maternal BMI. An indirect significant relationship with childhood obesity was also shown if a parent was home when the child got home from school and if a father participated in exercise with their child. Caloric intake, total time in physical activity, demographic variables, and father's BMI showed no significant relationship with children's BMI. CONCLUSION: Interventions should be designed targeting total time spent on the computer, total time watching television, and maternal obesity in child obesity programs.

Effect of creatine supplementation on body composition and performance: a meta-analysis.

BACKGROUND: Creatine supplementation (CS) has been reported to increase body mass and improve performance in high-intensity, short-duration exercise tasks. Research on CS, most of which has come into existence since 1994, has been the focus of several qualitative reviews, but only one meta-analysis, which was conducted with a limited number of studies. PURPOSE: This study compared the effects of CS on effect size (ES) for body composition (BC) variables (mass and lean body mass), duration and intensity (< or = 30 s, [ATP-PCr = A]; 30-150 s [glycolysis = G]; >150 s, [oxidative phosphorylation = O]) of the exercise task, type of exercise task (single, repetitive, laboratory, field, upper-body, lower-body), CS duration (loading, maintenance), and subject characteristics (gender, training status). METHODS: A search of MEDLINE and SPORTDiscus using the phrase "creatine supplementation" revealed 96 English-language, peer-reviewed papers (100 studies), which included randomized group formation, a placebo control, and human subjects who were blinded to treatments. ES was calculated for each body composition and performance variable. RESULTS: Small, but significant (ES > 0, p < or = .05) ES were reported for BC (n=163, mean +/- SE=0.17 +/- 0.03), ATP-PCr (n=17, 0.24 +/- 0.02), G (n=135, 0.19 +/- 0.05), and O (n=69, 0.20 +/- 0.07). ES was greater for change in BC following a loading-only CS regimen (0.26 +/- 0.03, p=.0003) compared to a maintenance regimen (0.04 +/- 0.05), for repetitive-bout (0.25 +/- 0.03,p=.028) compared to single-bout (0.18 +/- 0.02) exercise, and for upper-body exercise (0.42 +/- 0.07, p<.0001) compared to lower (0.21 +/- 0.02) and total body (0.13 +/- 0.04) exercise. ES for laboratory-based tasks (e.g., isometric/isotonic/isokinetic exercise, 0.25 +/- 0.02) were greater (p=.014) than those observed for field-based tasks (e.g., running, swimming, 0.14 +/- 0.04). There were no differences in BC or performance ES between males and females or between trained and untrained subjects. CONCLUSION: ES was greater for changes in lean body mass following short-term CS, repetitive-bout laboratory-based exercise tasks < or = 30 s (e.g., isometric, isokinetic, and isotonic resistance exercise), and upper-body exercise. CS does not appear to be effective in improving running and swimming performance. There is no evidence in the literature of an effect of gender or training status on ES following CS.

Association of Menstrual-Cycle Hormone Changes with Anterior Cruciate Ligament Laxity Measurements.

OBJECTIVE: To determine whether anterior cruciate ligament (ACL) laxity (as evaluated with the KT-2000 and radiographic measures) is associated with concentrations of reproductive hormones during the menstrual cycle and whether the KT-2000 knee arthrometer is a valid measurement technique, compared with radiographic techniques. DESIGN AND SETTING: A within-subjects linear model was used. Venipuncture was conducted in an exercise science laboratory. The KT-2000 and radiographic measurements were performed in a hospital radiology laboratory. SUBJECTS: Twelve females presented with a dominant right leg free of injury. They were mild to moderately active and had a 12-month history of normal menstrual cycles (28-35 days). Subjects had not used hormonal therapy for the previous 3 months. MEASUREMENTS: Subjects were tested at the onset of menses, near ovulation, and on day 23 of the midluteal phase of the menstrual cycle. At each session, 14 mL of blood was obtained by venipuncture. Blood samples were analyzed via radioimmunoassay to determine the relative levels of each hormone. Anterior cruciate ligament laxity was simultaneously measured by KT-2000 and radiographic techniques. RESULTS: Anterior cruciate ligament laxity measurements were significantly greater with the KT-2000 than with radiographic measurement. No significant differences were noted between menstrual-cycle phase and ACL laxity for either method. The concentration of luteinizing hormone was negatively correlated with laxity at the onset of menses using the radiographic technique. CONCLUSIONS: We found no associations between follicular-, ovulatory-, and luteal-phase hormonal concentrations and ACL laxity as measured on the KT-2000 and radiographs; no effects of menstrual-cycle phase on ACL laxity as measured by the KT-2000 and radiographs; and significant differences between KT-2000 and radiographic measures of ACL laxity.

Effects of dehydration and rehydration on the one-repetition maximum bench press of weight-trained males.

Dehydration, a common practice among competitive athletes in sports including weight classes, has uncertain effects on strength. This study examined the effects of passive dehydration (D, approximately 2 hours in a sauna) followed by rehydration (R, approximately 2 hours of rest with water ad libitum) on bench press one-repetition maximum (1RM). Ten weight-trained males (x +/- SE; age = 25 +/- 1 years; mass = 85.5 +/- 5.2 kg; height = 173.5 +/- 1.7 cm; body fat = 17.8 +/- 2.2%; 1RM = 118 +/- 8 kg) completed 2 testing sessions (E1/E2 and D/R) consisting of, respectively, 2 euhydration 1RM measurements separated by 2 hours of rest; and D 1RM followed by R 1RM. Testing sessions were administered in counterbalanced order and separated by 1 week. D resulted in increases (p < 0.005) in body temperature, urine specific gravity, hematocrit, and hemoglobin (calculated 8% decrease in plasma volume) as well as decreased body mass (p < 0.005). 1RM was decreased following D (111.4 +/- 7.2 kg) compared to both E1 (118 +/- 7.6 kg, p = 0.0015) and R (117.3 +/- 7.8 kg, p = 0.0023), with no significant difference between E1 and R. A significant association (r = -0.67, p < 0.05) was observed between percent lean body mass (%LBM) and the change in 1RM following D. In conclusion, passive dehydration resulting in approximately 1.5% loss of body mass adversely affects bench press 1RM performance. The adverse affects of dehydration seem to be overcome by a 2-hour rest period and water consumption.

Perturbation of cell cycle regulators in Peyronie's disease.

Peyronie's disease is a fibromatosis of the tunica albuginea, characterized by development of a plaque consisting primarily of collagen. It has been suggested that trauma to the erect penis is the inciting event. More recent research has focused on the cellular events leading to the dysregulated wound healing and plaque formation. Previous work has shown chromosomal aneusomies and this combined with an increased S-phase in plaque derived cell cultures suggests a perturbation in the cell cycle in this condition. The p53 protein has been shown to be an important cell cycle regulator and pro-apoptotic factor. Aberrant p53 function leading to cell immortalization and proliferation has been implicated in several human malignancies. We hypothesized that abnormal p53 function may explain the high proliferative ability of fibroblasts derived from Peyronie's plaques. This study was undertaken to study the presence and function of p53 and its downstream elements (p21, mdm-2) in Peyronie's disease cell cultures. Plaque-derived fibroblasts have been established in culture and characterized. These cells and control neonatal foreskin fibroblasts were subjected to 5 Gy of gamma radiation to induce DNA damage. After fixation, antibodies to p53 and its transcriptional elements were used to stain irradiated and non-irradiated cells and levels of p53, p21 and mdm-2 were quantified using combined immunofluorescence and flow cytometry. Non-irradiated plaque fibroblasts demonstrated the presence of p53, p21 and mdm-2 at baseline. In control foreskin fibroblasts no p53 or mdm-2 were detectable at baseline. In irradiated foreskin-derived cells significant changes in all elements were demonstrated indicating a fully functional p53 pathway and cell cycle checkpoint system in these cells. In contrast, plaque-derived cells showed no such alterations in levels of cell cycle regulators following irradiation. This is highly suggestive of an aberration of the p53 pathway in plaque-derived fibroblasts. Peyronie's plaque-derived fibroblasts demonstrated stabilization and defunctionalization of p53 protein combined with appropriate responses of its transcriptional elements. These findings may explain the high cell proliferation rates in these cells and suggests a role for perturbation of the p53 pathway in the pathogenesis of Peyronie's disease.

Use of creatine and other supplements by members of civilian and military health clubs: a cross-sectional survey.

A survey was used to collect anonymous cross-sectional data on demographics, exercise habits, and use of creatine and other supplements by exercisers in civilian (C) and military (M) health clubs. M (n = 133) reported more aerobic training and less use of creatine and protein supplements than C (n = 96, p <.05). Supplement users (SU, n = 194) and nonusers (SNU, n = 35) engaged in similar frequency and duration of aerobic exercise, as well as number of resistance exercise repetitions, but SU completed more sets for each resistance exercise (x- +/- SE, 5 +/- 1) than SNU (3 +/- 1, p < or =.05). Significant (p < or =.05) associations were observed between SU and resistance training goal of strength (as opposed to endurance), as well as greater frequency of resistance training. Male gender, resistance training goal of strength, lower frequency and duration of aerobic training, and use of protein, b-hydroxy-b-methyl butyrate, and androstenedione/dehydroepiandrosterone supplements were all associated with creatine use (p <.05). For creatine users, the dose and length of creatine supplementation was 12.2 +/- 2.7 g.day-1 for 40 +/- 5 weeks. Popular magazines were the primary source of information on creatine (69%) compared to physicians (14%) or dietitians (10%, p < or =.0001). This study underscores two potential public health concerns: (a) reliance on popular media rather than allied-health professionals for information on creatine, and (b) use of creatine, a popular supplement with unknown long-term effects, in combination with other anabolic supplements of questionable efficacy and/or safety.

Optimization of inpatient warfarin therapy: impact of daily consultation by a pharmacist-managed anticoagulation service.

OBJECTIVE: To determine the effect of daily consultation by a team of hospital pharmacists on the accuracy and rapidity of optimizing warfarin therapy. DESIGN: Comparison of a historical control cohort with a prospective cohort matched for treatment indication. SETTING: A 400-bed university teaching hospital. PATIENTS: Sixty consecutive patients hospitalized in 1992 and starting warfarin for the first time, with anticoagulation therapy managed by physicians, were compared with 60 patients matched for warfarin indication hospitalized in 1995, but with anticoagulation therapy managed with pharmacy consultation. RESULTS: Pharmacist management of initial warfarin therapy resulted in a significant reduction in the length of hospitalization compared with physician dosing, from 9.5 +/- 5.6 days to 6.8 +/- 4.4 days (p = 0.009). The number of patients and patient-days with international normalized ratio (INR) values >3.5 were reduced by pharmacist dosing from 37 patients and 142 days to 16 patients and 29 days, respectively (p < 0.001). Similarly, the number of patients and patient-days with INR >6.0 were reduced from 20 patients and 50 days to two patients and six days, respectively (p < 0.001). There were six documented bleeding complications in 1992 compared with one in 1995 (p = 0.11). The mean INR at discharge was significantly lower in the pharmacy surveillance group, 2.6 +/- 0.58, compared with the physician cohort, 3.3 +/- 2.1 (p = 0.07). Readmissions after discharge due to bleeding or recurrent thrombosis were reduced from five (at 1 mo) and 10 (at 3 mo) to two and five readmissions, respectively, by pharmacist intervention (p = 0.43). The number of patients with concurrently prescribed drugs known to significantly interact with warfarin was significantly lower (6 vs. 13; p = 0.02) in the pharmacy surveillance group. CONCLUSIONS: Among patients starting warfarin for the first time, daily consultation by a pharmacist significantly decreased the length of hospital stay and the number of patients who received excessive anticoagulation therapy. These findings translate into improved quality of care and potentially significant cost savings.